Background There is a short window of opportunity for early diagnosis and treatment of rheumatoid arthritis, that may be crucial for reaching remission and a low rate of radiographic progression. High resolution power doppler ultrasonography (PDUS) is helpful in early detection of synovitis and may help to select patients that will need early establishmet of treatment for RA.
Objectives To study whether the presence of basal power doppler signal in patients with early arthritis in a clinical basis treatment decision could predict the risk of receive treatment for AR at 3 and 12 months of follow-up.
Methods We studied the presence of ultrasonographic Power Doppler (PD) signal on 28 joints (shoulders, elbows, wrists, MCPs, knees) and 44 joints (28 joints and in addition hips, Tarsus, ankles and MTPs), with a mid-range equipment GE L5, in 70 patients with suspected early arthritis. The patients were included with at least one of the following inclusion criteria: a) Swelling in 2 or more joints b) pain in MCPs, MTPs and/or the wrists c) morning stiffness of more than 30 minutes with <12 months duration of the symptoms. Clinical treatment decision was not awared to basal power doppler results. Statistical study: Chi-square, Fisher exact test, p univariant and Odds Ratio calculation.
Results The presence of basal power doppler signal in ≥1 joints of 44 (PD44) at baseline shows statistically significant association with treatment with oral steroids (p<0.001, OR 8,6 (2,4–30,5), DMARD p 0.028, OR 4,2 (1,3–13,3), metotrexato (MTX) p 0.002 OR 6,6 (1,9–22,1) but not sulfasalazine (SSZ) (p 0.145) at 3 months and with steroids (p<0.0005 OR 14,8 (3,9–44,4), DMARDs (p<0.0005, OR 10,3 (2,6–40,4), MTX (p<0.0005, OR 8,67 (82,6–29,2)), sulfasalazine (p=0.001, OR 8,7 (2,2–33,9), at 12 months The presence of at least one joint with power doppler signal of 28 joints (PD28) was significantly associated to esteroids (p=0.003, OR 5,4 (1,8–16,8) and metotrexate (p=0.016, OR 4,1 (1,4–12,7) treatments in the first 3 months but not to other DMARDs p=0.146 (including sulfasalazine p=0.416) and with esteroid (p=0.01 OR 7,3 (2.2–24,9), DMARD, (p=0.03, OR 5,8 (1,8–18,7), MTX (p=0.012, OR 4,3 (1,4–12,8),and sulfasalazine (p=0.008, OR 4,9 (1,5–15,6) during first 12 months of follow-up. Predictive value of other risk factors for RA (RF, basal erosions=EROS BAS) is shown in the table below.
Conclusions Power doppler ultrasonography in at least one joint of 44 (PD44) may predict the patients that will need esteroids, any DMARD, MTX and SSZ teraphy in early arthritis at 3 and 12 months of follow-up. PD28 may predict the patients that will need esteroids, any DMARD, MTX and SSZ teraphy in early arthritis at 12 months, but may only predict the need of esteroid and MTX at three months.
Disclosure of Interest None declared
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