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OP0192 Adding ultrasound to the treat-to-target strategy shows no benefit in achievement of remission: results from the biodam cohort
  1. A Sepriano1,
  2. S Ramiro1,
  3. R Landewé2,
  4. D van der Heijde1,
  5. S Ohrndorf3,
  6. O FitzGerald4,
  7. M Backhaus3,
  8. M Larché5,
  9. J Homik6,
  10. A Saraux7,
  11. H Hammer8,
  12. L Terslev9,
  13. M Østergaard10,
  14. G Burmester3,
  15. B Combe11,
  16. M Dougados12,
  17. C Hitchon13,
  18. G Boire14,
  19. R Dadashova15,
  20. J Paschke15,
  21. E Hutchings15,
  22. W Maksymowych6
  1. 1LUMC, Leiden
  2. 2ARC, Amsterdam, Netherlands
  3. 3Charité, Berlin, Germany
  4. 4SVUH, Dublin, Ireland
  5. 5McMaster University, Hamilton
  6. 6University of Alberta, Edmonton, Canada
  7. 7CHU, Brest, France
  8. 8Diakonhjemmet Hospital, Oslo, Norway
  9. 9Copenhagen UH, Copenhagen
  10. 10Copenhagen UH, Copenhagen, Denmark
  11. 11CHU, Montpellier
  12. 12Descartes University, Paris, France
  13. 13University of Manitoba, Winnipeg
  14. 14University of Sherbrooke, Quebec
  15. 15CaRE Arthritis Ltd, Edmonton, Canada


Background While, a Treat-to-Target strategy (T2T), treating patients with rheumatoid arthritis (RA) towards a certain target (eg. clinical remission; T2T-REM), is highly recommended, several patients in clinical remission often have residual synovitis on ultrasound-imaging (US). This may result in silent radiographic progression and clinical flare. It is arguable whether targeting US-synovitis may result in “deeper” remission in clinical practice.

Objectives To assess whether using US in a T2T strategy leads to more patients meeting clinical remission than using only clinical information.

Methods Patients with RA who started or changed csDMARD and/or anti-TNF treatment followed in centers with expertise in US and participating in BIODAM (2-year multicenter prospective observational cohort) were included. Clinical and US data [by the US7-score that includes 7 joints of the clinically dominant hand and foot for synovitis and tenosynovitis on gray-scale US (GSUS) and power-doppler US (PDUS) and erosions on GSUS] were collected every 3 months. Per visit was decided whether the patient was treated according to the clinical definition of T2T with remission as benchmark (T2T-CLIN-REM). Though not mandatory, US-data could also be used for this purpose. T2T-CLIN-REM was considered correctly applied if: either i) a patient already had a disease activity score below the remission target (i.e. ACR/EULAR boolean remission) or ii) if not, treatment was intensified. A T2T strategy taking also US data into account (T2T-CLIN-US-REM) was considered correctly applied if: either i) both clinical and US remission (all joints included in the US7-score with GSUS synovitis <2 and PDUS synovitis=0) were present; or ii) if not, the treatment was intensified. The main outcome was ACR/EULAR boolean remission. The effect of adding US to T2T (T2T-CLIN-US-REM) on clinical remission 3 months later compared to a clinical remission benchmark only (T2T-CLIN-REM) was analyzed using generalized estimating equations with auto-regression.

Results In total 963 visits of 130 patients were included. T2T-CLIN-US-REM was correctly followed in 33% of the visits, T2T-CLIN-REM in 14%, and any of these in 52%. Remission according to the ACR/EULAR-boolean definition was achieved in 19.6% of the visits. Compared to the conventional T2T-CLIN-REM strategy, using a combined clinical and US benchmark for T2T led to a lower – instead of higher - likelihood of ACR/EULAR-boolean remission 3 months later [OR (95% CI): 0.39 (0.24; 0.63] (table).

Conclusions Our results, from a non-randomized study, did not suggest an advantage of using US of 7 joints in addition to clinical examination as a T2T benchmark as compared to clinical examination alone in getting RA patients into clinical remission.

Disclosure of Interest None declared

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