Ultrasound Detected Tenosynovitis in Rheumatoid Arthritis Patients in Clinical Remission

Florencia Beatriz Mollerach¹, Josefina Marin², Johana Zacariaz², Marina Scolnik³, Javier Rosa², Santiago Ruta³ and Enrique R. Soriano⁴, ¹Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, ²Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio, Buenos Aires, Argentina, ³Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, CABA, Argentina, ⁴Rheumatology Unit, Internal Mecine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: rheumatoid arthritis (RA) and ultrasound

Session Information

Date: Monday, November 6, 2017

Title: Rheumatoid Arthritis – Clinical Aspects Poster II: Pathophysiology, Autoantibodies, and Disease Activity Measures

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: ultrasound (US) has demonstrated subclinical synovitis in rheumatoid arthritis (RA) patients in clinical remission, but there is less information regarding US tenosynovitis. The aims of the present study were to evaluate prevalence of US detected tenosynovitis in RA patients in clinical remission, its association with other features of the disease and to assess whether US detected tenosynovitis could add to US synovitis in order to define US remission in these patients.

Methods: consecutive RA patients (2010 ACR/EULAR criteria) in clinical remission according to DAS28<2.6 were included. All patients underwent US examination by the same rheumatologist using a MyLab 70 machine (Esaote) provided with a linear probe (6-18 MHz). Synovitis and tenosynovitis were defined according to OMERACT preliminary definitions. Grayscale (GS) and Power Doppler US (PDUS) were graded for both tenosynovitis and synovitis from 0 to 3. The following tendons were bilaterally assessed: 1^st to 6^thextensor tendon compartments at wrist level, 2^nd to 5^th finger flexor tendons and posterior tibial and peroneal tendons. Joints assessed bilaterally were: wrist, 1^st to 5^th MCP and 2^nd to 5^th proximal IP. US remission was defined as the absence of both GSUS grade ≥ 2 and any PDUS signal at both joint and tendon level.

Results: 60 RA patients were included (table). GSUS tenosynovitis grade ≥ 2 and PDUS tenosynovitis were found in 14 (23%, CI95%:12-34) and in 13 (21.7%, CI95%:10-32) RA patients in clinical remission, respectively. The most frequent involved tendons were:6^thextensor wrist compartment, 3^rd finger flexor and posterior tibial.

Mean erythrosedimentation rate (ESR) and DAS28 values were higher in patients with US detected tenosynovitis than those without US tenosynovitis (19 vs 12.3, p=0.016 and 2.2 vs 1.9, p=0.025, respectively). In multivariate analysis, the only feature associated with the presence of US tenosynovitis was ESR (OR:1.11, 95%CI: 1.02-1.22). ESR showed an area under the ROC curve for the detection of US tenosynovitis of 0.71.

Twenty-nine (48.3%, CI95%: 35-60) patients had US detected synovitis and were not classified as in US remission. Adding data of US detected tenosynovitis, 6 more patients would have been classified as not in US remission, giving a total of 35 (58.3%; CI95%: 45-70) (p=0.272).

Conclusion: about a quarter of RA patients in clinical remission had US detected tenosynovitis. The only feature associated with this US finding was the presence of higher levels of ESR. If US tenosynovitis is considered alongside with synovitis in the definition of US remission, a small number of patients would be added.

Features
Age (years), mean (SD)		59.6 (13.2)
Female, n (%)		51 (85)
Disease duration (months), median (IQR)		55.5 (26.5-102)
Positive RF, n (%)		37 (61.6)
Positive antiCCP, n (%)		46 (76.6)
ESR, mean (SD)		13.9 (7.8)
DAS28, mean (SD)		1.9 (0.4)
DMARDs, n (%)		53 (88.3)
Biologic therapy with TNFi, n (%)		12 (20)
Tofacitinib, n (%)		2 (3.3)
US remission, n (%; CI95%)		25 (41.6; 28-54)
No US remission	US detected only synovitis, n (%; CI95%)	21 (35; 22-47)
	US detected only tenosynovitis, n (%; CI95%)	6 (10; 2-17)
	US detected both synovitis and tenosynovitis, n (%; CI95%)	8 (13.3; 4-22)
	Total, n (%; CI95%)	35 (58.3; 45-70)

Disclosure: F. B. Mollerach, None; J. Marin, None; J. Zacariaz, None; M. Scolnik, None; J. Rosa, None; S. Ruta, None; E. R. Soriano, Abbvie, BMS, Novartis, Janssen, Pfizer, Roche, UCB, 2,Abbvie, BMS, Novartis, Janssen, Pfizer, Roche, UCB, 5,Abbvie, BMS, Novartis, Janssen, Pfizer, Roche, UCB, 8.

To cite this abstract in AMA style:

Mollerach FB, Marin J, Zacariaz J, Scolnik M, Rosa J, Ruta S, Soriano ER. Ultrasound Detected Tenosynovitis in Rheumatoid Arthritis Patients in Clinical Remission [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/ultrasound-detected-tenosynovitis-in-rheumatoid-arthritis-patients-in-clinical-remission/. Accessed .

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