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OP0181 Ultrasonography as Predictor for Flare in Rheumatoid Arthritis Patients with Low Disease Activity: Nine Month Results from Poet-Us-Study
  1. F.B.G. Lamers-Karnebeek1,
  2. T. Jansen2,
  3. P. van Riel1,
  4. J. Luime3,
  5. J. Jacobs4
  1. 1Rheumatology, Radboud university medical center, Nijmegen
  2. 2Rheumatology, Viecuri medisch centrum, Venlo
  3. 3Rheumatology, Erasmus medical center, Rotterdam
  4. 4Rheumatology, University medical center Utrecht, Utrecht, Netherlands

Abstract

Background A significant number of rheumatoid arthritis (RA) patients can reach low disease activity (LDA) by using TNF-inhibitors (TNF-i), but this therapy can cause serious side-effects and is expensive. Therefore it could be expedient to stop in case of LDA, especially if relapse can be predicted. Ultrasonography of joints seems to be a predictor in this respect in smaller studies.

The Dutch POET (Potential Optimalisation of Expediency of TNF-i (TNF-inhibitor)) study, is a multicenter randomized prospective cohort study investigating if in patients with RA with LDA on TNF-i and conventional DMARD, the TNF-i can be stopped. Patients were randomized to continue or stop TNF-i. Part of this study is the POET-ultrasonography (US) study.

Objectives To investigate whether US at the time of stopping TNF-i in RA patients with LDA can predict future flare.

Methods Data of patients who stopped TNF-i in the POET study were used for this analysis. Participating patients had RA according to ACR 1987 criteria, >6 months a DAS28 <3.2 (LDA) and treatment with TNF-i > one year next to a conventional DMARD, without dose change in the past six months. Nineteen trained ultrasonographers performed US at baseline of the study, using different US machines, of 20 joints (bilaterally: MCP 1-5 dorsal and volar, wrists and MTP 2-5 dorsal aspect). The joints were graded on grayscale (GS; 0-3) and power doppler (PD; 0-3). US signs of arthritis were defined as GS>1 and/or PD>0. Trial visits were performed every 3 months and when flare was suspected. Flare was defined as DAS28>3.2 and at least >0.6 increase compared to the DAS28 at inclusion. Cox regression was performed to compare TNF-i free LDA between patients with versus those without US signs of arthritis (figure).

Results Nine months data were available for 248 patients. Twenty-one percent was lost to follow-up and censored at last observation. Higher age, longer disease duration, anti-CCP and IgM-RF positivity were all related to flare occurrence. Patients with US signs of arthritis in one or more joints had a greater risk of flare (HR 1.77; 95% CI of 1.16 to 2.70) and shorter relapse-free period compared to patients without US signs of arthritis (see figure). The table shows patient- and US-characteristics at inclusion for patients without flare within 9 months versus patients with flare.

Conclusions On the group level, US can predict flare in RA patients with LDA in whom TNF-i is stopped.

Disclosure of Interest F. Lamers-Karnebeek Grant/research support from: Abbvie, T. Jansen: None declared, P. van Riel: None declared, J. Luime: None declared, J. Jacobs: None declared

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