Background To optimize therapy in rheumatoid arthritis (RA) patients (pts), it would be beneficial to identify those pts who are going to suffer joint damage before X-ray - erosions occur, to allow more potent and expensive therapy to be targeted to those who would benefit most. Musculoskeletal ultrasound (US) is more sensitive than conventional radiography (CR) in the detection of erosive disease.
Objectives We used a new US score of joint damage to identify whether changes seen in US examination of RA pts can predict of disease progression.
Methods One hundred nine pts (85% women) with RA [median age 53 (range 45-58) years; disease activity score-28 (DAS28) 6.5 (5.5-7.0); 74% “+” for rheumatoid factor (RF) and 82% “+” for anti-citrullinated peptide antibodies (ACCP))] were enrolled. US examination (“Voluson-i” (GE, USA), 4-13 MHz probe) was performed by one examiner at baseline, 6 months. Erosions were scored for presence (break in cortical bone in two perpendicular planes: ≥2 mm in one plane, ≥1 mm in the second plane). An US score was developed to determine of bone erosions in the most affected joints included bilateral sum of 5 joints (0-10): the wrist, II-III MCP and II-III PIP joints (US-Er-10). Pts were difined as US progressing cases when the change (Δ) of the US-Er-10 >1 units per 6 months. The van der Heijde-modified Sharp score (vdHSS) was calculated and other disease activity markers were measured.
Results The progression of US score of bone damage was observed in 84 (77%) cases. Pts were divided into two groups according to ΔUS-Er-10 score: 1st group (n=24) – pts with ΔUS-Er-10 ≥3 (rapid US progression), 2nd (n=60) – with ΔUS-Er-10 <3. We compared the changes seen in the US at 6 months with the X-ray erosion status at just 1 year. In subgroup RA pts with disease duration less two years Δ total vdHSS at one year [median 13.5 (range 3-23) vs. 0 (0-0) units, p<0.029] and RF [278 (117-514) vs. 9.5 (0-168), p=0.019] were higher in those who had rapid US progression (n=10) than in other group (n=11).There were no significant differences in baseline US score or laboratory data and clinical disease activity markers between pts who developed progressive damage and those who did not. Meanwhile, in pts with disease duration >2 years were not found significant associations between the change of US score of structural damage and follow-up X-ray – erosions.
Conclusions This pilot study has shown a new US score (US-Er-10) to predict X-ray - erosive status in early-stageRA. The change in the US score may be used to target pts who require aggressive, expensive therapy.
Disclosure of Interest None Declared