Background Until now there are no unequivocal prognostic parameters predicting reliably treatment success or failure in early RA patients. Ultrasound (US) predicts progression to RA in undifferentiated patients (1,2) and flare and erosive progression in RA patients in remission.(3) In early RA patients treated to target the added value of US to predict clinical outcomes has not been investigated.
Objectives We investigated whether in newly diagnosed RA patients findings of an US examination of joints at baseline added to clinical, laboratory and radiographical baseline findings would improve prediction of failure to reach DAS28 remission (<2.6) after one year.
Methods A multicentre cohort of newly diagnosed RA patients was followed prospectively for one year. US of hands (longitudinal (dorsal and palmar)), wrists and feet (longitudinal (dorsal)) was performed at baseline using an Esaote MyLab 60 (LA6-18MHz). Grey scale (GS) and power Doppler (PD) US was scored semiquantitatively (0-3). A joint was considered to be ultrasonographically inflamed if GS>1 and/or PD>0. Clinical, laboratory and radiographical parameters were recorded. Primary outcome was the absence of DAS28 remission 12 months after diagnosis, analysed using logistic regression.
Results 194 patients were included, of whom 174 patients were left for the analysis, with complete data for 158. The addition of US results (OR (95% CI) 0.96; 0.89-1.04) to a multivariate model already including DAS28 at time of diagnosis (OR (95% CI) 1.6; 1.2-2.2), female gender (OR (95% CI) 1.9; 0.91-4), presence of rheumatoid factor (OR (95% CI) 2.3; 1.1-5.1) and type of monitoring strategy (OR (95% CI) 0.2; 0.05-0.85), did not significantly improve prediction of failure to reach DAS28 remission. This resulted in a non-significant Likelihood ratio test: 1.04 (p=0.31).
Conclusions In conclusion, in an early RA population, treated according to the “treat to target” paradigm, adding an ultrasound examination of joints at baseline to the prognostic workup did not improve prediction for not reaching DAS28 remission.
Filer et al (2011) ARD.
Salaffi et al (2010) CER.
Foltz et al (2012) A&R.
Acknowledgements Dr. Naredo and the Ultrasound School of the Spanish Society of rheumatology, for use of their GSUS scoring system
Funding: This work was supported by an unrestricted grant from Roche Nederland B.V. Roche had no involvement in the study design; in collection, analysis and interpretation of data; writing of the report; and decision to submit for publication. The corresponding author had full access to all data and had final responsibility for the decision to submit for publication. The US machines were granted by (in alphabetical order) Abbott, MSD, Pfizer, Schering Plough and UCB. These companies did not have any involvement in the study design; in collection, analysis and interpretation of data; writing of the report; and decision to submit for publication.
Disclosure of Interest None declared
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