Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
The use of musculoskeletal ultrasound is increasing in rheumatology practice. Recently we have shown that use of power Doppler signal (PD) on ultrasound in the wrists and hands in patients who present with non-specific musculoskeletal symptoms and are anti-CCP antibody positive can aid the identification of those who will develop an inflammatory arthritis (IA). 1The aim of this study was to investigate the ultrasound findings at a joint-level in these patients and the use of PD in identifying patients who progressed to inflammatory arthritis (IA).
Methods
In a prospective observational cohort study, patients with new non-specific MSK symptoms and positive anti-CCP underwent imaging with ultrasound at baseline and were followed up for the development of IA. Patients attended for regular follow-up assessments and if necessary were seen earlier if joint symptoms changed. PD findings of the wrists, MCPs and PIPs were scored using a semi-quantitative method from 0 to3 PD using a standard method. Using multilevel binary logistic regression we modelled the association between presence of PD score>0 at baseline and presence of IA in that joint at follow-up; joints (level 1) were nested within patients (level 2).
Results
Our first 100 consecutive patients (73 females, mean age 51 years) were followed up for median 19.8 months (range 0.1-69.0); 50 developed IA after a median 7.9 months (range 0.1-52.4), 34 within 12 months. The majority who progressed to IA in at least 1 joint (43/50) fulfilled the 2010 ACR/EULAR criteria for rheumatoid arthritis. A total of 2200 joints were scanned. The majority of patients (67%) did not have any PD signal present; maximum score in any joint was 1 in 17% and 2 in 16%. None had a joint scoring 3. Progression to clinical synovitis was rare in joints scoring 0 (5% progressed) compared to joints scoring 1 (16%) or 2 (59%). The presence of positive PD signal (any score >0) in a joint at baseline was associated with a 10-fold increase in odds of the joint developing clinical swelling [OR=10.6 (5.3, 21.1), p<0.001].
Conclusion
Our findings suggest that in patients presenting with non-specific MSK symptoms and are anti-CCP antibody positive, ultrasound features of inflammation at a patient- and at a joint-level can aid the identification of patients at risk of developing IA. Results of our larger cohort will be presented.
1. Rakieh C, Nam JL, Hunt L, Hensor EM, Das S, Bissell LA, et al. Predicting the development of clinical arthritis in anti-CCP positive individuals with non-specific musculoskeletal symptoms: a prospective observational cohort study. Ann. Rheum. Dis. 2014.
Disclosure:
J. L. Nam,
None;
L. Hunt,
None;
E. M. A. Hensor,
None;
P. G. Conaghan,
None;
R. J. Wakefield,
None;
P. Emery,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasound-power-doppler-findings-in-the-wrists-and-hands-joints-of-anti-ccp-antibody-positive-individuals-with-non-specific-musculoskeletal-symptoms-and-the-development-of-inflammatory-arthritis/