FRI0588 Ultrasound could have prevented dmard escalation in rheumatoid arthritis with fibromyalgia. (12th June 2018)

• Record Type: Journal Article
• Authors: Chakr, R.; Santos, J.C.O.; Alves, L.D.S.; Andrade, N. P. B.D.; Ranzolin, A.; Brenol, C.V.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 817
• Page End: 818
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.2538
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Despite the growing body of evidence, the proper use of ultrasound (US) in monitoring disease activity still needs better understanding. 1, 2 As an objective measure, US could prevent overtreatment in situations of overestimation of clinical disease activity, such as fibromyalgia, present in up to 20% of patients with rheumatoid arthritis (RA). 3–5 Objectives: To verify how ultrasound (US) could impact rheumatoid arthritis (RA) treatment decision in real life when fibromyalgia (FM) was also present. Methods: A retrospective cohort study was performed from 2011 through 2016, including RA patients with FM. Patients were grouped according to US examination (Group DAS28: never performed US examination; Group US: at least one US exam). RA was considered active if DAS28 ≥3.2 in Group DAS28 or PD ≥2 in any single joint in Group US. Results: Out of 230 RA patients, 22 women with concomitant FM (Group DAS28=10 and Group US=12) were seen in 280 visits from 2011 through 2016. DAS28 was 4.4 (2.5–6.3) vs. 4.0 (2.0–5.0) (p=0, 592) in Groups DAS28 and US, respectively. DMARD treatment was escalated in 12.9% of visits in Group DAS28 versus 8.2% in Group US (p=0.791) (table 2). The relative risk (RR) for DMARD escalation in Group US compared to Group DAS28 was 1.08 (95%CI 0.60–1.95). However, in 74% of visits in Group US, DMARD was escalated despite a negative US result. In a theoretical scenario where US result oriented treatment decision, DMARD was escalated in 3.6% of visits in Groups DAS28 and US, respectively (table 1). Also, in this US-based scenario, the RR for DMARD escalation in Group US compared to Group DAS28 was 0.39 (0.19–0.83). The proportion of visits with US evaluation increased over time, nonetheless the level of agreement between US synovitis (PD ≥2) and DMARD escalation decreased (figure 1). Despite indicating US examination more frequently, rheumatologists did not base their DMARD escalation decision on PD synovitis. Conclusions: In this real-life study of RA patients with FM, the growing use of US for evaluating RA activity over time was associated with an increasing discordance between US result and clinical judgement. When clinical judgement and US findings were discordant, RA treatment decision was mostly based on clinical judgement. If US result oriented treatment decision, DMARD escalation risk would be 61% smaller. References: [1] Dale J, et al. Ann Rheum Dis. 2016;75(6):1043–50. [2] Haavardsholm EA, et al. BMJ2016;354:i4205. [3] Ranzolin A, et al. Arthritis Rheum. 2009;61(6):794–800. [4] Chakr RM, et al. Rev Bras Reumatol2016. doi:10.1016/j.rbr.2016.11.004 [5] Lage-Hansen PR, et al. Scand J Rheumatol2015. doi:10.3109/03009742.2015.1046484:1-4 Acknowledgements: This study was funded by Hospital de Clínicas de Porto Alegre. Disclosure of Interest: None declared