Session Information
Date: Sunday, November 13, 2016
Title: Imaging of Rheumatic Diseases - Poster I: Ultrasound and Emerging Technologies
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Previous publications have suggested that patients in clinical remission with residual ultrasound (US) synovitis flare more often and do not stay in remission as long as those without residual US synovitis. Those studies based essentially on Doppler mode have been performed in single centers by a few highly skilled operators. Recent studies performed among real life cohort have however shown that the predictive value of US could be not be as clear as previously suggested. The objective of this study was to investigate the predictive value of US residual synovitis on loss of remission in a real life settings and in particular how the time point when ultrasound was performed influence remission survival
Methods: This is retrospective longitudinal cohort study nested into the Swiss RA registry (SCQM) registry. It included all RA patients with at least one US score done in clinical remission (DAS<2.6) and at least two clinical evaluations implemented in the registry between 2009 and 2016. US significant residual synovitis was based on the Swiss SONAR score, which adopted the single joint definition of pathologies according to OMERACT for 22 joints using both a B mode and a Doppler mode. Flare was defined as DAS >2.6 or change in medication. Duration of remission was calculated either since the first visit before US with a DAS <2.6 or the last visit with a DAS>2.6. An early US subset group was defined when US performed within 6 months after start of remission. Left and right imputation analysis were applied to better estimated the real duration of remission before and after US was performed. Several cofactors for loss of remission were also analyzed.
Results: 264 RA patients were included. 328 eligible remission phases were available. 103/261 remissions were considered as early US (<6 months) according to the predefined mode of calculation. 198 loss of remission was objectivized in the overall cohort and 84 in early US subgroup. Time in remission before US whatever score used was the only independent covariate factor in both the overall cohort and the early US subgroup. The table summarized the hazard ratio for loss of remission adjusted for time in remission and other covariate using left (L) and right imputation (R) according to: B mode (>2 grade 2 synovitis), Doppler mode and combined score in the total cohort and in the early USsubset . Median times to loss of remission using B mode were 2.1 (95% CI: 1.4, 2.4) for US- and 1.1 year (95% CI: 0.9, 2) for US+ (log-rank p-value = 0.024) in the early subset group (right imputation). 
Figure below summarize Kaplan -Meyer plot of time to loss of remission in the early US subset group according to a: B mode, b: Doppler mode, c: combined scores (left / right imputation).
Conclusion: Our study confirmed that ultrasound has a modest independent predictive value for loss of remission when applied in a real life cohort. In this condition, US done early in remission using B mode seems to have the best predictive value.
To cite this abstract in AMA style:
Zufferey P, Tamborrini G, Moeller B, Ciurea A, Brulhart L, Blumhardt S, Toniolo M, Ziswiler HR. Ultrasound Performed Among RA Patients in Real Life Setting Can Predict Loss of Remission, Especially When Done Early after Reaching Remission [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/ultrasound-performed-among-ra-patients-in-real-life-setting-can-predict-loss-of-remission-especially-when-done-early-after-reaching-remission/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasound-performed-among-ra-patients-in-real-life-setting-can-predict-loss-of-remission-especially-when-done-early-after-reaching-remission/