Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
To assess the relationship between inflammation and joint destruction in RA patients who have not responded clinically to treatment using Musculoskeletal US as a sensitive tool to evaluate structural damage as well as residual synovial inflammation.
Methods:
Changes from baseline to week 54 in clinical variables and measures of radiographic progression were compared between RA patients who received anti-TNF biologic therapy (Treat-to-Target approach), and those who received DMARDs therapy (standard protocol). Musculoskeletal US was used to assess for underlying radiographic progression and inflammatory status. Patients were divided into: in remission, low (LDA), moderate (MDA) and high (HDA) disease activity at 1-year of treatment according to DAS-28 score. Radiographic progression in both hands and feet was scored at base line and at 54 weeks using the modified total Sharp score (MSS). In addition, US examination of individual joints, both hands and feet, was carried out and scores for, number of erosions as well as synovial hypertrophy and PD using a validated semi-quantitative method (0–3) were recorded.
Results:
At week 54, the progression of MSS, US-GS as well as US-PD scores in MDA and HDA cohorts were significantly lower in the biologic therapy than the DMARDs group: (P< 0.01). On comparing the MSS scores, the biologic therapy cohort who showed LDA (DAS-28: 2.6-3.1) exhibited no significant difference from the DMARDs cohort showing the same LDA status; whereas there was significant difference on comparing US-GS and US-PD scores (P< 0.001) between both groups of patients. On the other hand, the biologic therapy cohort showing DAS-28 score > 3.2 had significantly less number of erosions and joint space narrowing (P< 0.001) as well as US-GS and US-PD scores in comparison to the DMARDs therapy cohort.
In the DMARDs group, 1-year MSS progression in LDA, MDA and HDA was 0.40±0.88, 1.04 ±1.73, and 1.31±3.02, respectively, whilst in the remission group, it was 0.1 + 0.64. Analysis using US revealed: LDA: 0.86+0.65, MDA: 2.15+1.82, HAD: 2.73+1.94 whilst in the remission group it was 0.12+0.57. In contrast, in the biologic therapy cohort, MSS progression was 0.32±0.26, 0.57±0.42, and 0.63±0.44, (for LDA, MDA and HDA respectively). Similar findings were found on comparing US scores for the inflamed joints: 0.31±1.06, 0.93±0.42, and 1.05±0.37, (for LDA, MDA and HDA respectively) whereas in remission there was no significant difference between the 2 patients groups.
US-GS synovial score and/or US-PD score ≥2 increased the risk of structural progression: OR= (1.36–2.98) p<0.001.
Conclusion:
The combination of biologic therapy and DMARDs retards damage independently of its effects on disease activity, contrasting DMARDs therapy. This indicates that beyond cytokine blockade, biologic therapy conveys profound anti-destructive effects and dissociates the link between disease activity and joint damage.
This study confirms the validity of the presence of US determined synovial thickness and PD signal for predicting subsequent structural deterioration and that US joint examinations may be relevant to optimally evaluate the risk of subsequent structural deterioration.
Disclosure:
Y. El Miedany,
None;
M. El Gaafary,
None;
S. Youssef,
None;
A. Nasr,
None.
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