Session Information
Date: Sunday, November 8, 2015
Session Title: Imaging of Rheumatic Diseases Poster I: Ultrasound, Optical Imaging and Capillaroscopy
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Several ultrasound (US) studies have shown a high frequency of inflammation in clinically inactive joints of rheumatoid arthritis (RA)patients. There is controversy in the conduct to be followed in these situations, raising the question of whether a change in the therapeutic approach can prevent the clinical flare of this joints. Objective:To determine the utility of US assessment of clinically inactive joints to predict short-term joint flares in patients with RA.
Methods: :A cohort study including patients with diagnosis of RA (ACR-EULAR 2010 criteria) was designed. Patients were evaluated at baseline and at 3 months, including clinical and ultrasonographic examination of 28 joints. Power Doppler (PD) signal and grayscale (GS) synovitis were graded from 0 to 3, according to standards OMERACT, yielding an overall US score (US-global) resulting from addition of both scores (range 0 -6, 6 being the highest degree of US synovitis). At baseline, the joints were classified as active vs. inactive according to clinical examination (swollen vs. non-swollen). Baseline inactive joints of patients who did not change their treatment were identified. Primary endpoint was defined as the presence of joint clinical flare (development of joint swollening in physical examination in a previously non-swollen joint) at three months follow-up. To evaluate the ability of US to predict joint flare multivariable logistic regression using the US score at baseline as the independent variable adjusted by the presence or absence of joint pain was developed. Based on the multivariate model, the area under the curve (AUC) and the probability of having a joint flare for the different levels of basal US involvement was calculated.
Results: We included a total of 49 patients. The disease duration was 8 ± 5 years, 85% were women, with a mean age of 53 ± 10 years.The mean of DAS28 was 4.8 ± 1.5. A total of 1372 joints were assessed, of which 1079 (79%) were clinically evaluated inactive. These joints showed a mean overall US score of 0.6 ± 0.8 (PD = 0.1 ± 0.3; GS = 0.5 ± 0.6). In patients without treatment variations between visits (n=24; 49%), 518 non-swollen joints at baseline were analyzed separately. Of these joints, 28 (5%) developed a flare at 3 months. In multivariate analysis the presence of pain and the grade of US involvement at baseline were associated with greater likelihood of joint flare (OR: 3.5; 95%CI=1.1-11.4 and OR: 2; 95%CI=1.4-2.9, respectively). Figure 1shows the probability of developing joint flare at 3 months according to the US baseline score and the presence of pain.
|
US Score |
Probability of flare |
|
|
Pain present |
Pain absent |
|
|
6 |
87% |
65% |
|
5 |
77% |
48% |
|
4 |
62% |
32% |
|
3 |
45% |
19% |
|
2 |
29% |
10% |
|
1 |
17% |
5% |
Conclusion: US evaluation could be helpful for decision-making in non-swollen joints. The likelihood of developing a flare at three months varies from 5% to 87% depending on the US findings and the presence of joint pain.
To cite this abstract in AMA style:
Cazenave T, Waimann CA, Zamora N, Citera G, Rosemffet MG. Utility of Ultrasound Synovitis Assessment As a Predictor of Flares in Clinically Inactive Joints [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/utility-of-ultrasound-synovitis-assessment-as-a-predictor-of-flares-in-clinically-inactive-joints/. Accessed December 6, 2019.« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/utility-of-ultrasound-synovitis-assessment-as-a-predictor-of-flares-in-clinically-inactive-joints/