THU0138 Das 28 correlated poorly with the objective evidence of inflammation as detected by ultrasound (US) examination of hands and feet in patients with established rheumatoid arthritis (RA)

Abstract

BackgroundThe Disease Activity Score including 28 joint count (DAS-28) is the most widely used outcome measure in RA. However, despite evidence that metatarsophalangeal (MTP) joints are often the first joints affected in RA, DAS-28 score does not incorporate them.ObjectivesOur study aimed to investigate the correlation between DAS-28 assessment and objective evidence of active joint inflammation using the US examination of both hands and feet, including wrists, metacarpophalangeal (MCP), proximal interphalangeal (PIP), and MTP joints.MethodsA retrospective study was conducted, including 87 patients who were referred to the US clinic for an examination of their hands and feet in the last 6 months (46 patients with RA and 43 controls - patients with other inflammatory or degenerative arthropathies). Information about demographics, disease duration, current treatment, inflammatory markers, and DAS-28 scores was captured. The US OMERACT criteria were used for grading synovial hypertrophy, and assessing for the presence of Power Doppler (PD) signal, erosions and osteophytes. Statistical analysis methods included T-test, Mann-Whitney U test, Z score for proportions and Spearman's correlation coefficients.ResultsIn the RA group, DAS-28 had a weakly positive correlation with the cumulative PD scores of their hands and feet joints (R=0.14, P=0.02), but did not correlate with PD score of MTP joints (R=0.03, P=0.09). In the control group, DAS-28 did not correlate significantly with either the total PD scores of feet (R=0.42, P=0.26) or hands and feet joints (R=0.5, P=0.25). Sensitivity of US examination of hands alone compared to hands and feet was 74.3% for the RA group, while the sensitivity of US feet to detect the presence of PD was 59.2% when compared to the US of both hands and feet.ConclusionsWe found that DAS-28 correlated poorly with objective evidence of inflammation as detected by US of the hands and feet, and this correlation was lost when only the presence of inflammation in the feet was taken into consideration. Further validation of our results in a larger study including patients stratified based on the disease duration might help understand which patient subgroups are more likely to have their disease activity significantly under-evaluated using DAS-28 outcome measure.Disclosure of InterestNone declared

Sirukumab and adalimumab reduce power Doppler ultrasound signal in patients with rheumatoid arthritis by 4 weeks in a phase III trial

“…At Week 24, for combined treatment groups, PDUS change did not significantly correlate with clinical activity change (Week 24 minus baseline) by any measure (p>0.05) consistent with previous reports 5 6. In contrast, at Week 24, GSUS change correlated with changes in all clinical activity scores evaluated (r=0.40–0.59) except DAS28-CRP.…”

EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis

“… 38–45 In a study in established patients with RA in whom there was explicit doubt about the presence of inflammation, only weak and non-statistically significant correlations between US sum scores and composite indices were found. 46 This suggests that US may be better related to ‘true’ inflammatory activity in these patients and may have additional value in patients with D2T RA in whom a doubt about the presence of inflammatory activity exists. However, the minimal number of joints that should be included in an US assessment remains unclear, 41 which hampers the use of a sum score to determine the overall level of disease activity in daily practice.…”

“…[38][39][40][41][42][43][44][45] In a study in established patients with RA in whom there was explicit doubt about the presence of inflammation, only weak and non-statistically significant correlations between US sum scores and composite indices were found. 46 on August 29, 2021 by guest. Protected by copyright.…”

Diagnostic issues in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis

“…Only one study (moderate RoB) explicitly evaluated patients in whom there was doubt about the presence of inflammation, although this study did not report appropriate diagnostic association measures. 25 In patients who had symptoms suggestive of inflammatory joint pain, weak or non-statistically significant correlations were found between DAS28 and US sum scores (US sum scores of hands and feet: r=0.14; US sum scores of MTP joints: r=0.03). In established patients with RA in whom there was not explicit doubt about the presence of inflammation, moderate to strong correlations between US sum scores and composite indices were found in eight other papers (range of r: 0.40–0.70, statistically significant (s) in six of eight papers (two low RoB, five moderate RoB, one high RoB)).…”

“…In this study, only weak and statistically non-significant correlations were reported between an US sum score and DAS28. 25 In the general population of RA patients who are not treatment naïve, US was studied most extensively among all diagnostic tests in papers with low to moderate RoB. 24 27 35 40 67 74 78 83 All papers reported moderate to strong correlations between DAS28 and US sum scores, although also here appropriate diagnostic association measures were not reported.…”