Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Rheumatoid Arthritis (RA) disease activity outcomes are used for treatment decisions (ie. DAS28-ESR). Surgically operated joints (SOJ) are assumed not to respond to therapy and are often not included in standard trials. This analysis examines whether a therapeutic benefit is conferred to SOJ over six months, as measured by grey-scale synovial hypertrophy (GSUS) and power Doppler (PDUS) synovitis scores.
Methods: 20 RA patients with SOJ enrolled in an open-label 24-week tocilizumab study. Participants’ joints were identified as SOJ (replaced, fusion, arthroscopy, tendon) or as a non-operated joint (NOJ). Joint assessments occurred at baseline, 1-mos, 3-mos, and 6-mos for: tender joint (0/1), swollen joint (0/1), GSUS (0-3), and PDUS (0-3). GSUS and PDUS images were captured for 32 joints including bilateral MCPs, PIPs, wrist, medial/lateral parapatellar knee recesses, and MTP 2-5. Maximum GSUS and PDUS scores across the views for each joint were calculated. Mean GSUS and PDUS scores from SOJ were compared to NOJ over time by mixed effects linear models analysis. GSUS and PDUS compared baseline to 6months using mixed effects models, while TJ and SJ used McNemar test.
Results: A significant difference between NOJ and SOJ over 6mos was seen for GSUS and PDUS (both p<0.0001) (Figure 1). There was a significant improvement in TJ for NOJ (p=0.02), however no difference seen in SOJ for SJ or TJ (Table 1). Of 37 SOJ joints assessed by ultrasound, 78% of joints had PDUS>1 and 86% of joints had GSUS>1 at baseline, while NOJ had 43% and 64% respectively. There was a significant GSUS response seen for the overall set of SOJ from baseline to 6-months (p=0.03), and a trend for PDUS (p=0.07).
Conclusion: RA activity measures such as DAS28-ESR require strict parameters to provide patient prognosis and treatment efficacy. Traditional trials exclude operated joints from measurement and analysis. This study suggests that SOJ joints exhibit significant synovitis. Response to tocilizumab over six months, by GSUS. Further research is needed to validate these findings, and this study suggests that ultrasound RA clinical studies should assess response in both SOJ and NOJ.
To cite this abstract in AMA style:Choate E, Kaeley GS, Brook J, Fitzgerald J, Elashoff D, Ranganath VK. Ultrasound Response to Tocilizumab in Surgically Replaced Joints and Surgically Operated Joint Areas of Rheumatoid Arthritis Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/ultrasound-response-to-tocilizumab-in-surgically-replaced-joints-and-surgically-operated-joint-areas-of-rheumatoid-arthritis-patients/. Accessed June 6, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasound-response-to-tocilizumab-in-surgically-replaced-joints-and-surgically-operated-joint-areas-of-rheumatoid-arthritis-patients/