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AB0948 Power Doppler Ultrasound Monitoring of Response to Anti-TNFα Treatment in Patients with Rheumatoid Arthritis
  1. A. Iagnocco,
  2. F. Ceccarelli,
  3. C. Perricone,
  4. A. Finucci,
  5. A. Gattamelata,
  6. V. Iorgoveanu,
  7. G. Valesini
  1. Rheumatology Unit, Sapienza Università di Roma, Rome, Italy

Abstract

Background Joint synovial inflammation is the primary abnormality in rheumatoid arthritis (RA) and monitoring of the response of synovitis to treatments has a fundamental importance in the management of RA patients. Power Doppler ultrasound (PDUS) has been demonstrated to be valid, reliable and sensitive-to-change in RA. However, its routine use in daily rheumatologic practice is often considered time-consuming, particularly in the assessment of the characteristic poly-articular involvement of the disease (1).

Objectives To monitor by PDUS the short term response to anti-TNFα therapy in 6 “target joints” of RA patients and to correlate PDUS findings with clinical and laboratory indexes of disease activity.

Methods Consecutive RA patients starting anti-TNFα therapy were included and studied at baseline and after 3 months of treatment. All patients were evaluated by PDUS at the level of 6 “target joints” (II MCP, wrist and knee bilaterally). The components of synovitis (synovial hypertrophy, joint effusion, PD signal) were analyzed and graded according to a 0-3 semi-quantitative score. In addition, by differently summing the PDUS findings, 3 different scores were calculated: a joint score (0-18; at II MCP, wrist and kneejoints), a single inflammatory lesion score (0-18; synovial hypertrophy, joint effusion, PD signal) and a global score at patient level (0-54; sum of all abnormalities). Finally, clinical (N° tender joints; N° swollen joints; VAS;DAS28) and laboratory (ESR; CRP) assessments were conducted. Wilcoxon and Spearman's tests were used for statistical analysis.

Results 68 RA patients (M/F 11/57; mean age 53.0±15.2 years, mean disease duration 143,6±41.0 months) treated with anti-TNFα therapy (45 etanercept, 23 adalimumab; 52 in combination with DMARDs) were included. A significant decrease of the joint score in all articular sites (MCP P=0.003; knee P=0.002; wrist P=0.0001) as well as of the scores of the single components of synovitis (P=0.0001-0.002) and of the global 6-joint score (P=0.0001) was found. In addition, all clinical and laboratory parameters were significantly decreased at follow-up (P=0.0001-0.001). Finally, a significant positive correlation was observed between the global PDUS score and DAS28 (r=0.38; P=0.001).

Conclusions PDUS is a sensitive-to-change imaging modality for the monitoring of short-term response to anti-TNFα treatment in RA patients. The assessment of the response to treatment in a limited number of joints makes the evaluation feasible in the daily rheumatologic practice as a complimentary tool to clinical assessment.

References

  1. Perricone C, Ceccarelli F, Modesti M, Vavala C, Di Franco M, Valesini G, Iagnocco A. The 6-joint ultrasonographic assessment: a valid, sensitive-to-change and feasible method for evaluating joint inflammation in RA.Rheumatology (Oxford). 2012;51:866-73.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.3352

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