Background Physical function is one of the major outcomes in rheumatoid arthritis (RA) which can predict work disability, quality of life and mortality. It has been shown that multiple factors are associated with functional disability in patients (pts) with RA, including diseases activity and radiographic damage. It is currently still unclear whether ultrasound (US) - detected inflammation and/or erosion status has an impact on physical function during tocilizumab (TCZ) treatment.
Objectives To identify factors associated with functional disability in RA and to evaluate the link between the US finding of synovitis and/or joint damage at baseline with improvement in physical function after 6 months of treatment with TCZ.
Methods 36 adult pts with RA (median age 51 (range 43-57) years; disease duration 54 (24-96) months) according to the ACR 1987 criteria who had been scheduled to receive TCZ were registered and prospectively examined for 24 weeks. Data on clinical outcomes and physical function were collected using DAS28-CRP, SDAI and HAQ. One-year radiographic progression of the hands and feet was defined when the change of the van der Heijde-modified total Sharp score (vdHSS) more than 0.5 units per year. US assessment (“Voluson-i” (GE, USA), with 13-4 MHz linear array transducer) included bilateral the most affected joints: the wrist, II-III MCP and II-III PIP joints. Each joint was scored according to the OMERACT definitions of pathology . Functional disability at baseline and the course of physical function after treatment were estimated using the Wilcoxon test.
Results Thirty-five of 36 pts (97.2%) at baseline had functional disability. All pts were divided into two groups according to the HAQ values at baseline: 1t group (n=16) – HAQ≥2 (severe disability), 2nd (n=20) – HAQ<2. Pts with severe disability had higher baseline DAS28-CRP [6.9 (6.4-7) vs. 6.2 (5.8-6.8), p<0.03] and SDAI [52.5 (49-59) vs. 46.4 (39-54), p<0.04], than those who did not and the same tendency to US erosions score (US-Er-10) [6 (4-8) vs. 4 (3-5), p=0.09] and total vdHSS [78 (53-123) vs. 49 (20-104) units, p<0.102]. But baseline GS- and PDUS scores of synovitis or disease duration did not differ between the groups. Achievement of normal physical function (HAQ <0.5) was observed in 41.6% of pts (15/36) at 24 weeks. Only in subgroup RA pts with disease duration less two years (n=9) have been established statistically significant relations HAQ at 6 month with baseline US-Er-10 (r=0.634, p=0.04) as well as baseline DAS28-CRP (r=0.705, p=0.02) and SDAI (r=0.678, p=0.03). Meanwhile, significant inverse correlation was observed between HAQ at 6 month and baseline PDUS score (r= - 0.821, p=0.003). The total vdHSS score was not associated with HAQ at any of the time points examined.
Conclusions High US erosions score and disease activity scores at baseline were associated with severe functional disability in RA and less improvement in physical function. In contrast, high PDUS score was not correlated with loss of physical function. PD signal may be used to detect patients who require aggressive, expensive therapy especially in early RA.
Wakefield RJ, Balint PV, Szkudlarek M et al. J Rheumatol 2005; 32:2485-7.
Disclosure of Interest None Declared