Very Low Prevalence of Ultrasound Determined Tendon Abnormalities in Healthy Subjects Throughout the Age Range: An Outcome Measures in Rheumatology (OMERACT) Ultrasound Minimal Disease Study

Jeanette Trickey¹, Ilfita Sahbudin ², Alessandra Bortoluzzi ³, ANNAMARIA IAGNOCCO ⁴, Carlos Pineda ⁵, Cesar Sifuentes-Cantú ⁶, Coziana Ciurtin ⁷, Cristina Reátegui-Sokolova ⁸, Daniela Fodor ⁹, ESPERANZA NAREDO ¹⁰, Ellen-Margrethe Hauge ¹¹, Florentin Vreju ¹², Garifallia Sakellariou ¹³, George A. W. Bruyn ¹⁴, Georgios Filippou ¹⁵, Giuliana La Paglia ⁶, Gustavo Leon ¹⁶, Hélène Gouze ¹⁷, Helen Keen ¹⁸, Hilde Hammer ¹⁹, Ilaria Tinazzi ²⁰, Irene Azzolin ⁴, Jacek Fliciński ²¹, Kei Ikeda ²², Lene Terslev ²³, Mads Ammitzball Danielsen ²⁴, Mads Nyhuus Bendix Rasch ¹¹, Marcin Milchert ²¹, Maria Stoenoiu ²⁵, Marion Kortekaas ²⁶, Marwin Gutierrez ⁵, Mihaela Maruseac ²⁷, Mohamed Mortada ²⁸, Philippe Carron ²⁹, Rositsa Karalilova ³⁰, Ruth Wittoek ³¹, Sarah Ohrndorf ³², Takeshi Suzuki ³³, Teodora Șerban ³⁴, Maria-Antonietta D’Agostino ³⁵ and Andrew Filer ³⁶, ¹Institute of Inflammation and Ageing, University of Birmingham, Hereford, United Kingdom, ²Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom, ³University of Ferrara, Ferrara, Italy, ⁴Academic Rheumatology Centre, Università degli Studi di Torino, TURIN, Italy, ⁵Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico, Mexico, Mexico, ⁶Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain, ⁷Centre for Adolescent Rheumatology, University College London London, UK, Londond, United Kingdom, ⁸Hospital Guillermo Almenara Irigoyen. EsSalud, Lima, Peru, ⁹2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Cluj-Napoca, Romania, ¹⁰Rheumatology Department, Joint and Bone Research Unit. Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, MADRID, Spain, ¹¹Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, ¹²Department of Rheumatology, University of Medicine and Pharmacy Craiova, Craiova, Romania, ¹³Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy, ¹⁴Department of Rheumatology, MC Groep Hospitals., Lelystad, Netherlands, ¹⁵University of Ferrara, Cona, Italy, ¹⁶Instituto Nacional de Rehabilitacion, Mexico City, Lima, Peru, ¹⁷Rheumatology Department, APHP, Ambroise Paré Hospital, Bolougne Billancourt, France, ¹⁸School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia, ¹⁹Diakonhjemmet Hospital, Oslo, Norway, ²⁰Sacro Cuore Don Calabria Hospital, Unit of Rheumatology, Verona, Italy, ²¹Department of Rheumatology, Internal Diseases and Geriatrics; Pomeranian Medical University, Szczecin, Poland, ²²Chiba University Hospital, Chiba, Japan, ²³Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen, Denmark, ²⁴Copenhagen University Hospital, Copenhagen, Denmark, ²⁵Cliniques universitaires Saint-Luc - Université Catholique de Louvain - Institut de Recherche Expérimentale et Clinique, Bruxelles, Belgium, ²⁶Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ²⁷Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de recherche expérimentale et clinique (IREC), Université catholique de Louvain, Brussels, Belgium, ²⁸Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University, Egypt, Zagazig, Egypt, ²⁹Ghent University Hospital, Ghent, Belgium, ³⁰Clinic of Rheumatology, Medical University of Plovdiv, University Hospital “Kaspela", Plovdiv, Bulgaria, ³¹Ghent University Hospital, Gent University, Gent, Belgium, ³²Charité Universitätsmedizin Berlin, Berlin, Germany, ³³Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan, ³⁴SC Reumatologia, Ospedale La Colletta, Genoa, Italy, ³⁵Department of Rheumatology, APHP, Hôpital Ambroise Paré, Paris, France, ³⁶Institute of Inflammation and Ageing College of Medical and Dental Sciences University of Birmingham, Birmingham, United Kingdom

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: healthy, tendon, tenosynovitis and age, Ultrasound

Session Information

Date: Tuesday, November 12, 2019

Title: 5T089: Imaging of Rheumatic Diseases II (2750–2755)

Session Type: ACR Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Tenosynovitis (TS) is a common, often clinically undetectable finding in Rheumatoid Arthritis (RA). Recent data showed TS on ultrasound (US) has a role in predicting outcome in early disease and flare in clinical remission. However data is limited on US measured TS in healthy subjects (HS), none specifically encompassing the older age range when RA commonly presents. This OMERACT study aimed to determine prevalence of US measured tendon abnormalities in HS throughout the age range.

Methods: Adult healthy subjects without: joint pain (VAS < 10/100), hand osteoarthritis (ACR criteria), or inflammatory arthritis were recruited in 23 international centres from Aug 2017-Dec 2018. MCP, PIP and wrist joints were clinically examined. Bilateral digit flexor (DF) 1-5 and extensor carpi ulnaris (ECU) tendons were scanned for tenosynovial hypertrophy (TSH) and power Doppler (PD) signal and graded (OMERACT US scoring system). A comparison cohort of DMARD-naive patients with RA (ACR-EULAR 2010 and/or 1987 criteria) at presentation was taken from the Birmingham Early Arthritis (BEACON) inception cohort, who underwent identical tendon US assessment. They were grouped into ≤12 and > 12 weeks from symptom onset. Abnormal ultrasound findings were dichotomised in to grade 0 (absent) or grade 1-3 (present) for statistical analysis (Fisher’s exact test).

Results: Data from 899 HS and 144 RA patients were included. Prevalence of TSH and particularly PD abnormalities in HS was very low in all age groups, and was all grade 1 except in one individual ECU tendon. ECU TSH grade≥1 was more common than DF grade≥1 in the older HS groups, and less common in the 18-39 age group (p=0.011). TSH and PD of grade ≥1 were common in RA patients (p ≤0.001), with DF PD abnormalities more common in early disease (p=0.02).

Conclusion: Very low prevalence of TSH or PD abnormalities in tendons of healthy subjects even in old age suggests ultrasound determined tenosynovitis will be a robust tool in clinical management of RA.

ACR tendon abstract upload 1

Demographics and summary tendon data for healthy subjects by age groups, and RA patients by early and late presentation

ACR tendon abstract upload 2

Percentage of abnormal digit flexor and extensor carpi ulnaris tendons by age group of healthy subjects, and early or late presenters in RA patients

Disclosure: J. Trickey, None; I. Sahbudin, None; A. Bortoluzzi, None; A. IAGNOCCO, None; C. Pineda, None; C. Sifuentes-Cantú, None; C. Ciurtin, None; C. Reátegui-Sokolova, None; D. Fodor, None; E. NAREDO, None; E. Hauge, None; F. Vreju, Novartis, 5, Sandoz, 5, Ewopharma, 5, Abbvie, 8, Eli Lilly, 8; G. Sakellariou, None; G. Bruyn, None; G. Filippou, None; G. La Paglia, None; G. Leon, None; H. Gouze, None; H. Keen, None; H. Hammer, None; I. Tinazzi, None; I. Azzolin, None; J. Fliciński, None; K. Ikeda, Abbvie Japan, 8, AbbVie Japan, 8, Bristol-Myers Squibb Japan, 8, Mitsubishi Tanabe Pharma, 2, Novartis Japan, 8; L. Terslev, None; M. Danielsen, None; M. Rasch, None; M. Milchert, None; M. Stoenoiu, None; M. Kortekaas, None; M. Gutierrez, None; M. Maruseac, None; M. Mortada, None; P. Carron, None; R. Karalilova, None; R. Wittoek, None; S. Ohrndorf, Pfizer, 2; T. Suzuki, None; T. Șerban, None; M. D’Agostino, None; A. Filer, None.

To cite this abstract in AMA style:

Trickey J, Sahbudin I, Bortoluzzi A, IAGNOCCO A, Pineda C, Sifuentes-Cantú C, Ciurtin C, Reátegui-Sokolova C, Fodor D, NAREDO E, Hauge E, Vreju F, Sakellariou G, Bruyn G, Filippou G, La Paglia G, Leon G, Gouze H, Keen H, Hammer H, Tinazzi I, Azzolin I, Fliciński J, Ikeda K, Terslev L, Danielsen M, Rasch M, Milchert M, Stoenoiu M, Kortekaas M, Gutierrez M, Maruseac M, Mortada M, Carron P, Karalilova R, Wittoek R, Ohrndorf S, Suzuki T, Șerban T, D’Agostino M, Filer A. Very Low Prevalence of Ultrasound Determined Tendon Abnormalities in Healthy Subjects Throughout the Age Range: An Outcome Measures in Rheumatology (OMERACT) Ultrasound Minimal Disease Study [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/very-low-prevalence-of-ultrasound-determined-tendon-abnormalities-in-healthy-subjects-throughout-the-age-range-an-outcome-measures-in-rheumatology-omeract-ultrasound-minimal-disease-study/. Accessed .

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