Session Title: Imaging of Rheumatic Diseases: Various Imaging Techniques
Session Type: Abstract Submissions (ACR)
Persistent inflammation on Power Doppler (PD) by ultrasound (US) was associated with relapse and structural progression after one year of follow up in a cohort of RA patients in low disease activity (LDA).
Patients with RA (1987 ACR criteria) were included in 2007-2008 in one centre if their diagnosis of RA was recent (<8 yrs), and they were in LDA or remission according to DAS (i.e. DAS 44 ≤ 2.4). All patients underwent clinical and biological assessments every year. Hands and forefeet X-ray were performed at baseline and at 5 years and evaluated blindly by two investigators (van der Heijde Sharp score: mTSS). Progression was defined as a variation of the mTSS superior to the smallest detectable difference (SDD) of 6.6 points. The metacarpophalangeal (MCPs) joints 2-5 and wrist of the dominant hand were examined with a 0.2T dedicated MRI (ESAOTE C-scan); and bilateral wrists, MCPs 2, 3, 5 and metatarsophalangeal 2, 3, 5 were studied with high resolution US (ESAOTE Technos) at baseline and evaluated blindly using validated acquisition and OMERACT scoring systems (Skuldarek for US and RAMRIS for MRI). The association between the structural progression at 5 years and MRI/US covariates was measured by Wilcoxon Mann-Whitney tests or Fisher's exact test, then by a multivariate logistic regression (forward and backward procedure) to explain a progression > SDD.
85 patients were included: mean age 50.7 (±13.5) yrs; mean disease duration 35 (±20.7) months, 63.5% patients were anti-CCP positive and mean DAS44 was 1.5 (± 0.54). At baseline the median score [interquartiles] of the grade of synovitis for US and MRI was respectively 3 [1;5] and 3 [4;7]. The median of the number and the grade of synovitis PD positive were 0 [0;1]. The median of the number and the grade of bone marrow edema (BME) were 0 [0;0]. 17 patients (20%) and 8 patients (9%) had respectively score of PD or BME above the median. At 5 years, 13 patients of 70 followed up, were considered in progression. In bivariate analysis X-ray progression at 5 years was associated with baseline number of synovitis PD >0 (p= 0.0001), grade of synovitis DP>0 (p= 0.0001), and total RAMRIS>14 (p=0.03). In multivariate analysis the number of synovitis PD>0 (adjusted OR 9.8 [95% CI 1.7-4.1] was associated with X-ray progression.
Persistence of Doppler signal on US was the best predictor of structural progression on X-ray at short and long term, in a cohort of patients in LDA. Further studies should assess whether patient management guided by US may decrease relapses and X-ray progression.
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