Background/Purpose: Few prospective ultrasound (US) cohort studies of rheumatoid arthritis (RA) patients treated by biologic or targeted synthetic DMARDs (b/tsDMARDs) are reported. We have been prospectively investigating the course of active RA patients by US after b/tsDMARDs being introduced in Kyushu region, Japan from June, 2013. This is an interim report to explore the characteristic of RA patients classified as therapeutic responders evaluated by US after b/tsDMARDs being introduced. 

Methods: A total 150 RA patients were consecutively recruited from 12 rheumatology centers in  Kyushu region in Japan from June 2013 to June 2015. They gave their informed consent to be subjected to the protocol that was approved by the Institutional Review Board of Nagasaki University. Disease activity was consecutively evaluated by both US and clinical composite measures such as DAS28, SDAI every 3 months after introduction of b/tsDMARDs therapies. Twenty-two joints including MCP, PIP and wrist joints of bilateral hands were assessed by US for gray scale (GS) and power Doppler (PD) on semi-quantitative scale from 0 to 3 (each total scores from 0 to 66, respectively). The present data come from the first 6 months observation. We divided the patients into 2 groups by the mean total US scores at 6 months and the patients, total GS or PD score lower than the mean, were classified as therapeutic responders evaluated by US (US responders). We tried to find the characteristic of US responders at 6 months by multivariate logistic regression analysis.

Results: Eighty-six (30 patients in TNF inhibitors, 30 patients in tocilizumab, 23 patients in abatacept, 3 patients in tofacitinib, respectively) out of 150 patients, who completed the first 6 months observation, were evaluated. In overall, total GS and PD scores improved significantly at 6 months as compared to the baseline (p < 0.001, respectively). The mean total GS scores at 6 months were 8 (declined from 13 at baseline) whereas PD scores were 3 (declined from 8 at baseline), respectively. Among the baseline variables including age, gender, disease duration, ACPA (%), RF (%), the use of prednisolone (%), the use of MTX (%), bDMARDs-naïve (%), ESR (mm/hr), CRP (mg/dl), DAS28-ESR, SDAI, total GS score and total PD score, multivariate logistic regression analysis identified that total GS score at baseline (odds ratio 0.84, 95% C.I. 0.76-0.92, p < 0.001) is the only predictor of GSUS responder at 6 months. In case of PD, total PD score at baseline (odds ratio 0.86, 95% C.I. 0.77-0.94, p < 0.00１) and bDMARDs-naïve (odds ratio 3.83, 95% C.I. 1.29-12.32, p = 0.015) were the predictors of PDUS responder at 6 months.

Conclusion: The clinical characteristic of patients at baseline involves in US disease activity at 6 months treated by b/tsDMARDs. Physicians are recommended to pay attention to this information to consider the efficacy of DMARDs therapies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasound-evaluation-of-the-efficacy-of-biologic-and-targeted-synthetic-dmards-toward-rheumatoid-arthritis-patients-kyushu-multicenter-rheumatoid-arthritis-ultrasound-prospective-observational-cohor/