Background There is growing evidence in rheumatoid arthritis (RA) that ultrasound assessments (UA) have a better predictive value for X-ray progression than clinical assessments
Objectives To analyze the association between UA with a reduced 12-joint ultrasound (US) power Doppler (PD) examination and X-ray progression at 12 months
Methods Patients were included with available X-ray examination in a multicenter, observational, prospective cohort of RA patients with moderate disease activity (3.2≤DAS28≤5.1), conducted under conditions of routine daily practice (ECO-DAIStudy) 12-joint PDUS assessments were performed at baseline, 6 and 12 months. Synovitis grey scale (SGS) and PD counts were obtained, and each joint was semi-quantitatively assessed (0 – 3) to obtain SGS and PD scores. X-ray examinations were performed at baseline and at 12 months. An independent, blinded observer read paired films in chronological order and scored them according to Sharp-van der Heijde method. X-ray progression was defined as an increase >1 point and non-progression as ≤0. In order to increase contrast, patients with doubtful X-ray progression (>0 - ≤1) were excluded from association analyses of X-ray progression and US findings. Several cutoffs for SGS and PD were tested, and sensitivity (Se) and specificity (Sp) were computed when a significant association was found
Results The sample consisted of 129 patients, including 107 women (82.9%), with median (IQR) age of 56.0 (44.0-66.0) yrs, median time from diagnosis of 5.0 (3.0-11.5) yrs, and rheumatoid factor positivity in 82 patients (63.6%). At baseline, 6 and 12 months, the median (IQR) values of SGS counts were 5.0 (4.0-8.0), 5.0 (2.0-7.0) and 4.0 (2.0-6.0); SGS scores were 8.0 (5.0-11.0), 5.0 (3.0-8.0) and 5.0 (2.0-7.8); PD counts were 4.0 (2.0-6.0), 2.0 (1.0-4.0) and 2.0 (1.0-3.0); and PD scores were 6.0 (2.0-9.0), 3.0 (1.0-6.0) and 2.0 (1.0-5.0), respectively 3.5±3.9 (Friedman test; p<0.0005 all). At baseline and 12 months, median Sharp -van der Heijde's scores were 16.0 (3.5-45.0) and 20.0 (6.0-51.0) (p<0.0005). A total of 79 patients (61.2%) experienced x-ray progression; 36 patients (27.9%) had no sign of x-ray progression and it was doubtful (progression =1) in 14 patients (10.9%). X-ray progression was not significantly associated with grey scale synovitis counts or scores for any cut-off between 0.5 and 5.5 but was significantly associated with PD counts for cut-offs of 0.5 (Se, 80.3 – 96.2; Sp, 16.7 – 42.4) and 1.5 (Se, 57.9 – 88.6; Sp, 16.7 – 42.4) as well as with PD scores for cutoffs of 0.5 (Se, 80.3 – 96.2; Sp, 16.7 – 42.4) and 1.5 (Se, 69.7 – 94.9; Sp, 27.8 – 55.6)
Conclusions Power Doppler joint counts or cumulative scores greater than 0.5 or 1.5 in a 12-joint PDUS assessment are significantly associated with X-ray progression. Cutoff of 1.5 performed slightly better for PD-scores than for PD-counts. Grey scale synovitis counts or scores were not significantly associated with X-ray progression
Acknowledgements The authors wish to thank Jesus Garrido for providing medical writing and editing services in the development of this abstract. 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. Garcia Vivar Grant/research support from: AbbVie, J. Ivorra Grant/research support from: AbbVie, J. Rivas Employee of: AbbVie