BackgroundClinical remission is the treatment target for patients with rheumatoid arthritis (RA). However, different definitions have been proposed. Still, damage and/or subclinical inflammation (eg, positive Doppler signal) may persist despite apparent clinical remissionObjectivesTo examine the validity of different definitions of remission and Doppler ultrasound using X-Ray progression as the gold standardMethodsData were obtained from an observational, prospective, multicenter study in RA patients with moderate disease activity (3.2≤DAS28(CRP)≤5.1) who started anti-TNF therapy, conducted under conditions of daily practice. At recruitment and at months 6 and 12, patients were scheduled for a clinical examination, laboratory data collection and reduced 12-joints Power Doppler (PD) ultrasound examination of the wrist, 2nd and 3rd MCP, elbow, knee, and ankle bilateral joints. Synovitis grey scale and PD counts were obtained, and each joint was semi-quantitatively assessed (0 – 3) to obtain grey scale synovitis and PD scores. DAS28 (ESR/CRP), SDAI, CDAI, and ACR/EULAR remission criteria were collected. At baseline and month 12, radiographs of hands and feet were obtained and assessed by an independent observer in pairwise, chronological order and scored according to Sharp-van der Heijde method. X-Ray progression was defined as an increase >1 point and non-progression as ≤0. Patients with doubtful X-ray progression (progression =1), were excluded from independent tests of X-ray progression and US findingsResultsThe sample consisted of 129 patients, 107 women (82.9%), with median (IQR) age of 56.0 (44.0-66.0) years, median time from diagnosis of 5.0 (3.0-11.5) years, and positive rheumatoid factor in 82 patients (63.6%). At 12 months, Sharp-van der Heijde's score median increase was 3.0 (0.0-6.5) points, with 36 patients not progressing and 79 with progression (14 patients with doubtful X-ray progression). Remission rates at 6 and 12 months according to different clinical criteria were: CDAI, 10.5% and 15.9%, SDAI, 12.3% and 15.7%; ACR/EULAR, 12.6% and 14.2%, DAS28ESR, 21.1% and 33.9%; DAS28CRP, 45.9% and 56.7%, respectively. Disease activity at any study time by any composite index (DAS28ESR, DAS28CRP, SDAI, CDAI and ACR/EULAR) was not significantly associated with X-Ray progression. PD score ≥1 at baseline and persistence of PD score ≥1 at 6 months were associated with X-Ray progression: OR=5.067 (IC95%: 1.162 – 21.576; p=0.017), and OR=7.474 (IC95%: 2.644 – 21.123; p<0.0005), respectively.ConclusionsA short 12 joints PD US score shows better predictive validity for structural damage progression in RA than composite indices of disease activity. PD signal, but not clinical disease activity, can predict X-ray progression at 6 and 12 months. Probably in the near future Ultrasound may need to be considered as a component of RA remission criteria.AcknowledgementsThe authors wish to thank Jesus Garrido for providing medical writing and editing services in the development of this abstract and poster. The financial support ...

BackgroundThere is growing evidence in rheumatoid arthritis (RA) that ultrasound assessments (UA) have a better predictive value for X-ray progression than clinical assessmentsObjectivesTo analyze the association between UA with a reduced 12-joint ultrasound (US) power Doppler (PD) examination and X-ray progression at 12 monthsMethodsPatients 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 foundResultsThe 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)ConclusionsPower 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 progressionAcknowledgementsThe authors wish to thank Jesus Garrido for providing medical writi...