Background Ultrasound (US) (grey scale (GS) and power Doppler (PD)) is sensitive for scoring of synovitis in patients with rheumatoid arthritis (RA). The RA Impact of Disease (RAID) score is a patient developed questionnaire including pain, functional capacity, fatigue, physical and emotional wellbeing, quality of sleep and coping, with answers converted to a score of 0-10.
Objectives In a routine clinical setting to explore the associations between a comprehensive US examination, clinical tests and the RAID score in a one-year follow-up of RA patients on biologic treatment.
Methods RA patients starting biologic treatment were consecutively included and examined at baseline and after 1, 2, 3, 6 and 12 months with US of 36 joints (wrist (radiocarpal, intercarpal and radioulnar), MCP 1-5, PIP 2-3, elbow, knee, talocrural, MTP 1-5) and 4 tendons (ext. carpi ulnaris and tib.post. tendons). PD and GS synovitis were scored semi-quantitatively (0-3) with a US atlas as reference, and sum PD and GS scores from all joints and tendons were calculated. The patients were assessed clinically by a trained study nurse including global VAS, number of swollen/tender joints (of 28) and ESR/CRP. Patients completed RAID and the score was computed. Spearman’s rank test was used for correlations, Paired samples t-test to explore changes from baseline to follow-up and group differences were examined by Mann-Whitney U test.
Results 62 patients (mean (SD) age 54 (12) years, 89% women, disease duration 9 (8) years, 86% anti-CCP positive) starting biologic treatment (infliximab n=14, etanercept n=20, adalimumab n=4, golimumab n=2, certolizumab pegol n=1, rituximab n=12, abatacept n=2, tocilizumab n=7) were included. All disease activity variables improved significantly from baseline (p<0.01) (median (IQR) values in the table). At 12 months, ≤ 1 swollen joint was found in 50%, DAS28(ESR) remission in 40%. At all examinations PD and GS scores were significantly correlated with number of swollen joints (r=0.58-0.74, p<0.001), assessor`s global VAS (r=0.55-0.74, p<0.001), DAS28(ESR) (r=0.25-0.56, p ≤0.05) but not with RAID (r=0.01-0.20, NS). Comparisons between groups with ≤ 1 or > 1 swollen joint at the 12 months examination as the dependent variable, showed significant lower scores for PD and GS as well as assessor’s global VAS at all examinations (p<0.01), lower DAS28 at 2, 6 and 12 months (p<0.05) but no significant differences for RAID at any of the examinations.
Conclusions All the variables showed significant decrease during the study. However, close associations were only found between US scores and clinical examinations of disease activity, and not between assessments of joint inflammation and RAID scores. These findings indicate that inflammatory activity and subjective evaluation of disease impact are poorly related and should be evaluated and managed separately.
Disclosure of Interest None Declared
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