SAT0107 Sequential ultrasound shows a late increase in inflammatory burden in anti-ccp positive patients with non-specific musculoskeletal symptoms just before progression to inflammatory arthritis. (12th June 2018) - Pentony, P.
Abstract : Background: US abnormalities occur in patients with new rheumatoid arthritis (RA) and can also predict the development of clinical synovitis in anti-CCP positive patients with musculoskeletal symptoms (MSK) (CCP+) [1]. However, the timing of development of US synovitis in relation to clinical synovitis has not been longitudinally studied. Objectives: To investigate whether US synovitis (grey scale (GS) and power doppler (PD)) changes in the period prior to the development of inflammatory arthritis (IA) in CCP+ individuals compared to those who do not develop IA. Methods: CCP+ individuals were prospectively followed until the development of clinical synovitis in at least one joint (progressors). Progressors were compared to CCP+ individuals who did not develop clinical synovitis (non-progressors). For all subjects, US scans were performed at baseline, 6 and 12 months and then annually, and/or at the time of onset of clinical synovitis. A 22 paired joint US score was calculated for PD and GS >1 using the wrists, MCPJs (1-5) and PIPJs (1-5). Comparisons were made between baseline, the ultrasound prior to progression (or time equivalent in non-progressors)(scan 2) and progression scan (or time-equivalent) (scan 3). Results: Patients with at least 3 serial US were included: 22 CCP+ progressors and 22 CCP+ non progressors. Age and gender was similar between groups. The majority of patients in both groups showed no change in PD or GS>1 between baseline and scan 2 (table 1). All 22 non-progressors (100%) had a PD score of 0 at baseline, compared with 16/22 (72.7%) progressors. In contrast, between scan 2 and 3 (progression scan), the majority of patients in the progressor group increased total PD and GS scores, while non-progressors remained the same (table 1). Time between scan 2 and 3 was similar between groups. Conclusions: After a period of stability the burden of US inflammation in CCP+ patients that progress to IA increases directly before the development of IA. This later increase in US inflammation may reflect a second hit in these at risk patients occurring prior to progression to IA. This may suggest that an intervention aiming to prevent the development of IA should target the subclinical phase prior to an escalation in US inflammation. Reference: [1] Nam JL, et al. Ultrasound findings predict progression to inflammatory arthritis in anti-CCP antibody-positive patients without clinical synovitis. Ann Rheum Dis 2016;75(12):2060-2067. Disclosure of Interest: None declared