Article Text

SAT0513 Imaging Rather than Clinical Inflammation is Associated with Radiographic Progression in Tocilizumab-Treated Rheumatoid Arthritis Patients
  1. R. Osipyants1,
  2. D. Karateev1,
  3. E. Panasyuk1,
  4. A. Smirnov1,
  5. G. Lukina1,
  6. S. Glukhova1,
  7. E. Alexandrova1,
  8. A. Volkov1,
  9. E. Nasonov1
  1. 1Federal State Budgetary Institute for Rheumatology «Scientific Research Institute for Rheumatology», RAMS, Moscow, Russian Federation


Background The main target for patients with rheumatoid arthritis (RA) is to establish a state of remission. Clinical studies demonstrated a disparity between of disease activity and structural damage. Power Doppler (PD) ultrasonography (US) is capable to provide a more accurate measure of disease activity and to predict long-term radiographic outcomes.

Objectives To assess the significance of residual inflammation according to the presence of swollen joint count (SJC) and PD-signals in relation to radiographic progression in patients receiving anti-interleukin (IL)-6 receptor antibody - tocilizumab (TCZ).

Methods Prospective analysis of 36 consecutive RA patients [median age 51 (range 43-57) years; disease duration 54 (24-96) months; disease activity score-28 (DAS28-CRP) 3.9 (2.2-4.6); 72 % female; 82.8% «+» for rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACCP)] in therapy with TCZ. The patients underwent clinical, laboratory, and US evaluation at baseline and 6 months. US assessment of the wrist joints was performed by a single operator, unaware of clinical data (“Voluson-i” (GE, USA) with transducer (4-13MHz)). Each joint was scored according to the OMERACT definitions of pathology. The residual inflammation was defined using SJC as a measure of clinical inflammation and PD-signals as a measure of imaging activity. Both variables were dichotomised into “non- or low-active” (SJC≤1, PD≤1) and “middle- or high-active” (SJC>1, PD>1). One-year radiographic progression of the hands and feet was defined when the change of the van der Heijde-modified total Sharp score (∆ total Sharp score) more than 0.5 units per year. The functional status assessed by the Health Assessment Questionnaire Disability Index (HAQ).

Results Twenty-one patients (58%) achieved a radiographic remission (∆ total Sharp score < 0.5) at one year, of whom 9 patients (42.8%) had a functional remission (HAQ < 0.5) from baseline to 6 months. Non- or low-active PD-signals and SJC were observed in 8 (22.2%) and 10 (28%) cases at 6 month, respectively. The total Sharp score at one year was significant higher [93 (56-131) vs. 32.5 (19.5-83) units, p<0.04] in patients with middle- or high-active PD-signals (n=27) than in cases with lower imaging activity or the absence of the PD-signals (n=8) at 6 month. Likewise, in patients with non- or low-active SJC at 6 month (n=10) we found lower radiographic progression over one year [55 (31-116) vs. 88.5 (55-130), p<0.205], than those with SJC>1 (n=25). However, it has been shown only tendency, but no significant difference. Furthermore, ∆ total Sharp score was significantly positively correlated with PD-signals of residual inflammation of the wrists at 6 month (r=0.696, p=0.011), but there was not found correlation with SJC status.

Conclusions In TCZ-treated patients the US-imaging activity score appears to be more predictive of radiographic progression than SJC status. PD-signals more than 1 may be useful for identifying individual RA patients at high risk of the progression very early in the disease, before erosions can be detected by X-ray.

Disclosure of Interest None Declared

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