Objectives To evaluate the sensitivity to change over one year of a combined gray-scale (GS) and power Doppler (PD) US score in RA patients taking different anti-rheumatic therapies in comparison to synovitis sum scores of 5 joints (US5).
Methods USdata of 77 RA patients have been surveyed over the time of one year since inclusion of each patient. The clinically most affected hand (wrist and finger joints) was semi-quantitatively (0-3) assessed by GS and PDUS for synovitis (synovial fluid and/or synovial hypertrophy) . In detail, radiocarpal, ulnocarpal and midcarpal wrist as well as the MCP2-5 and PIP2-5 joints were examined from dorsal and palmar at baseline, and 3, 6, 12 months after initiation/change of therapy (DMARD/Biologic). The combined score was the highest of either the GS or PDUS score with the same weight at joint level . Each combined score was correlated to the 5-joint sum score of the wrist and hand (dorsal ulnocarpal, dorsal and palmar midcarpal regions, dorsal (only PDUS) and palmar MCP2,3 and PIP2,3 regions according to  without forefoot) at patient level each in GS and PDUS. Clinical examination by DAS28 was performed at the same time points than US. Correlations between the combined scores, the GS/PDUS5, and DAS28 were obtained by Spearman’s correlation coefficient.
Results After baseline examination, 71.2% of included patients were on Biologic and 28.8% on DMARD therapy. The combined scores demonstrated longitudinal significant correlations with the DAS28 only in the dorsal midcarpal (r=0.29, p=0.015) and ulnocarpal (r=0.24, p=0.47) wrist regions, whereas the US5 sum score presented higher significant correlations both in GS (r=0.42, p<0.01) and PDUS (r=0.54, p<0.01). Including all time points, the highest correlations between the joint-level combined scores and the GSUS5 score were found for the following joint regions: midcarpal wrist from palmar (r=0.69) and from dorsal (r=0.63), ulnocarpal wrist (r=0.73), palmar MCP2 (r=0.76), palmar MCP3 (r=0.66; each p<0.01).
Conclusions Considering the whole patient group independently from therapy, the proposed combined score was only sensitive to change at the wrist joint level (dorsal midline and ulnocarpal) under different anti-rheumatic therapies. The US5 sum score was higher responsive independently from the US modality (GS/PDUS).
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Disclosure of Interest None Declared