Background Clinical remission is the treatment target for patients with rheumatoid arthritis (RA). However, different definitions have been proposed. Still, damage and/or subclinical inflammation (eg, positive Doppler signal) may persist despite apparent clinical remission
Objectives To examine the validity of different definitions of remission and Doppler ultrasound using X-Ray progression as the gold standard
Methods Data were obtained from an observational, prospective, multicenter study in RA patients with moderate disease activity (3.2≤DAS28(CRP)≤5.1) who started anti-TNF therapy, conducted under conditions of daily practice. At recruitment and at months 6 and 12, patients were scheduled for a clinical examination, laboratory data collection and reduced 12-joints Power Doppler (PD) ultrasound examination of the wrist, 2nd and 3rd MCP, elbow, knee, and ankle bilateral joints. Synovitis grey scale and PD counts were obtained, and each joint was semi-quantitatively assessed (0 – 3) to obtain grey scale synovitis and PD scores. DAS28 (ESR/CRP), SDAI, CDAI, and ACR/EULAR remission criteria were collected. At baseline and month 12, radiographs of hands and feet were obtained and assessed by an independent observer in pairwise, chronological order and scored according to Sharp-van der Heijde method. X-Ray progression was defined as an increase >1 point and non-progression as ≤0. Patients with doubtful X-ray progression (progression =1), were excluded from independent tests of X-ray progression and US findings
Results The sample consisted of 129 patients, 107 women (82.9%), with median (IQR) age of 56.0 (44.0-66.0) years, median time from diagnosis of 5.0 (3.0-11.5) years, and positive rheumatoid factor in 82 patients (63.6%). At 12 months, Sharp-van der Heijde's score median increase was 3.0 (0.0-6.5) points, with 36 patients not progressing and 79 with progression (14 patients with doubtful X-ray progression). Remission rates at 6 and 12 months according to different clinical criteria were: CDAI, 10.5% and 15.9%, SDAI, 12.3% and 15.7%; ACR/EULAR, 12.6% and 14.2%, DAS28ESR, 21.1% and 33.9%; DAS28CRP, 45.9% and 56.7%, respectively. Disease activity at any study time by any composite index (DAS28ESR, DAS28CRP, SDAI, CDAI and ACR/EULAR) was not significantly associated with X-Ray progression. PD score ≥1 at baseline and persistence of PD score ≥1 at 6 months were associated with X-Ray progression: OR=5.067 (IC95%: 1.162 – 21.576; p=0.017), and OR=7.474 (IC95%: 2.644 – 21.123; p<0.0005), respectively.
Conclusions A short 12 joints PD US score shows better predictive validity for structural damage progression in RA than composite indices of disease activity. PD signal, but not clinical disease activity, can predict X-ray progression at 6 and 12 months. Probably in the near future Ultrasound may need to be considered as a component of RA remission criteria.
Acknowledgements The authors wish to thank Jesus Garrido for providing medical writing and editing services in the development of this abstract and poster. The financial support for these services was provided by AbbVie.
Disclosure of Interest E. de Miguel Grant/research support from: AbbVie, E. de Vicente Grant/research support from: AbbVie, F. Diaz Alcazar Grant/research support from: AbbVie, J. de la Iglesia Grant/research support from: AbbVie, M. L. Garcia Vivar Grant/research support from: AbbVie, J. Uson Jaeger Grant/research support from: AbbVie, J. Ivorra Grant/research support from: AbbVie, J. Rivas Employee of: AbbVie
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