FRI0042 Tender joints have low agreement with patient's evaluation of spontaneous joint pain, joint swelling and ultrasound verified synovitis in patients with established rheumatoid arthritis. (12th June 2018)

• Record Type: Journal Article
• Authors: Hammer, H.B.; Sexton, J.; Michelsen, B.; Provan, S.; Uhlig, T.; Kvien, T.K.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 567
• Page End: 568
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.2236
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Tender joint count is included in the clinical composite scores (CDAI, SDAI, DAS28) which serves as a proxy for inflammatory activity. However, there may be several causes of joint tenderness, including both nociception and central sensitisation. Ultrasonography (US) is sensitive for evaluation of joint inflammation (synovitis (grey scale, GS) and vascularisation (power Doppler, PD)). Objectives: In patients with rheumatoid arthritis (RA) to explore the agreement at a joint level between tenderness, spontaneous patient reported joint pain, swelling and US synovitis. Methods: 174 patients with established RA (mean (SD) age 52 13 years, disease duration 10 8 years, 82% women, 79% anti-CCP positive were assessed when they initiated bDMARD treatment and after 1, 2, 3, 6 and 12 months. An experienced study nurse assessed presence/absence of joint tenderness and swelling (wrist, MCP1–5, PIP2–3, elbow, knee, ankle and MTP1–5 bilaterally). The same 32 joints were assessed by use of a manikin for Patient Reported Spontaneous Joint Pain (PRSJP) the last day as well as US (GS and PD, both scored 0–3) by an experienced sonographer (HBH). Agreement at joint level was explored between categorical variables using Cohens kappa (US scores transformed to presence (PD score 1–3/GS score 2–3) versus absence (PD score 0/GS score 0–1), and in addition agreement between presence of tenderness/swelling and the different US scores were explored. Results: A total of 4091 (baseline) and 22 885 (all visits) joints were assessed. Tender joints had moderate agreement with PRSJP and swollen joints, and lower with US synovitis. Swollen joints had high agreement with US synovitis (table 1), and US synovitis was found in 75% of swollen joints. There were no differences in agreement between results at baseline and all visits, or if subgroup analyses were performed of only finger joints. A clear relationship was found between increasing GS/PD scores and percentages of joints being swollen, but this association was not found for tender joints (table 2). Conclusions: Tender joints had weak agreement with presence of US synovitis, while swollen joints had strong agreement. PRSJP had moderate/weak agreement with all the other assessments. Presence of swelling was highly associated with the degree of US synovitis, while this association was not found for tenderness. Our results raise questions regarding the prominent role of tender joint count in RA clinical composite scores for disease activity. Disclosure of Interest: None declared