Background Tumor necrosis factor-α inhibitors (TNFi) are highly effective in patients with rheumatoid arthritis (RA), while not effective in all, with predictors of response being necessary. Although genetic, inflammatory and serologic biomarkers are under major investigation for this purpose, little is known about the predictive value of ultrasonographic parameters in RA.
Objectives To investigate the ability of ultrasonographic parameters to predict which patients with RA will benefit from the treatment with TNFi in terms of EULAR response.
Methods Biologic naive RA patients starting treatment with TNFi were examined longitudinally by ultrasonography (US) (both Gray-Scale [GS] and Power Doppler [PD]) of 28 joints according to standard scans of EULAR guideline and clinically (tender/swollen joint counts, DAS28 and HAQ scores) at baseline and after 3 months. US examinations were performed by an experienced sonographer (NI) using a MyLab 70 US machine (Esaote, Italy) equipped with 6-18 and 4-13 MHz broad band multi-frequency linear transducer. US synovitis and PD signals were semiquantitatively graded from 0 to 3. Total PD and synovitis scores of all sites are recorded as sum scores of PD and GS, respectively. The clinical response was evaluated according to the EULAR response criteria at 3rd month. Potential ultrasonographic predictors of response were identified using multivariate binary logistic regression models.
Results The study cohort consisted of 42 RA patients (F/M=33/9, mean age 49.0±10.7 years) with a mean disease duration of 9.1±7.5 years and mean baseline DAS28 score of 5.5±1.0. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (CCP) positivity were 76.2% and 64.3%, respectively. Baseline characteristics of TNFi responders (30/42) and non-responders (12/42) are shown in Table 1. Swollen joint count (p= 0.05), sum scores of baseline PD (p= 0.048), GS (p= 0.048) and PD+GS (p= 0.046) differed significantly between responders and non-responders. Baseline PD sum score was the only ultrasonographic parameter in the multivariate analysis predicting which patients achieve good/moderate EULAR response with TNFi at 3rd month (p= 0.004).
Conclusions Our data underline that baseline PD scores, despite similar clinical features, can predict which patients will respond to TNFi therapy.
Disclosure of Interest None Declared
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