Session Type: Poster Session (Sunday)
Session Time: 9:00AM-11:00AM
Background/Purpose: Power Doppler ultrasound (PDUS) has been shown to detect subclinical synovitis in psoriatic arthritis (PsA). The aim of this study was to evaluate PDUS features at joint level in patients with PsA in clinical remission and to investigate its value for predicting flares after one year of follow up.
Methods: Consecutive patients with PsA in clinical remission according to the attending rheumatologist and who fulfill minimal disease activity criteria and/or 28-joint Disease Activity Score in remission criteria underwent PDUS examination of 18 joints. All patients were followed up for 12 months. Disease flare was defined as any increase of disease activity generating the need of any of the following: changes in therapy with disease-modifying antirheumatic drugs (DMARD) by the attending rheumatologist: dose increase, switch or addition of a different DMARD, and/or switch or addition of biological therapies.
Results: Sixty patients with PsA in clinical remission (15 [25%] by DAS28, 12 [20%] by MDA, and 33 [55%], by both), were included. Fourteen patients (23%) were receiving biologics (5 as monotherapy and 9 combined with methotrexate (MTX), 27 (45%) were receiving MTX, 2 (3%) sulfasalazine, 1 (2%) leflunamide, and 16 patients were not receiving treatment. 18 (32%) experienced a flare within the next 12 months. Seventeen patients had at least 1 joint with PDUS synovitis at baseline, and 8 (44%) of these had a disease flare during the follow up period compared with only 10 of the 43 patients (21%) without baseline PDUS synovitis (relative risk = 2.1 (95% CI: 0.95 – 4.5; p=0.0698). On logistic regression analysis, PDUS synovitis was associated with short term flares: OR: 4.8, 95% CI: 1.12 – 20.9; p= 0.034), after adjusting for use of biologics, sex, age, disease duration, and baseline disease activity.
In 28 patients without flares a second US was performed within 12 months, in 6 (21%) the PDUS was positive (2 already positive in the first evaluation)
Conclusion: Among patients with PsA in clinical remission, PDUS-detected synovitis was present in around 20% of the patients and was predictor of short-term flares independently of treatment.
To cite this abstract in AMA style:Zacariaz Hereter J, Marin J, Acosta Felquer M, Brom M, Rosa J, Garcia Monaco R, Soriano E. Utility of Power Doppler Ultrasound–Detected Synovitis for the Prediction of Flare in Psoriatic Arthritis Patients in Clinical Remission [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/utility-of-power-doppler-ultrasound-detected-synovitis-for-the-prediction-of-flare-in-psoriatic-arthritis-patients-in-clinical-remission/. Accessed September 30, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utility-of-power-doppler-ultrasound-detected-synovitis-for-the-prediction-of-flare-in-psoriatic-arthritis-patients-in-clinical-remission/