AB0591 Sle res ponder index (SRI) underestimates clinical response in musculoskeletal systemic lupus erythematosus. (12th June 2018)

• Record Type: Journal Article
• Authors: Mahmoud, K.; Zayat, A.; Yusof, M.Y. Md; Hensor, E.; Conaghan, P.G.; Emery, P.; Vital, E.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 1448
• Page End: 1448
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.2919
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Musculoskeletal (MSK) manifestations are common in SLE. Many recent clinical trials were negative or had small benefits vs. placebo. SRI is a common primary endpoint but has not been independently validated. Ultrasound is an objective measure of synovitis validated in inflammatory arthritis. Objectives: To compare the responsiveness of clinical outcome measures with ultrasound in MSK-SLE. Methods: 20 SLE patients meeting SLICC 2012 criteria with inflammatory MSK symptoms were studied with clinical assessment (BILAG2004, SLEDAI-2K over 30 days, patient and physician VAS, symptomatic, tender and swollen joint counts in 28 joints) and MSK ultrasound (grey scale and power Doppler scores, number of abnormal joints) at 0, 2, and 4 weeks after 120 mg IM depomedrone. Change in each variable was measured using Wilcoxon matched pairs and effect sizes(r=Z/sqrt(2N) compared using Cohen (1988) criteria. Changes were compared for SRI-4 responders and non-responders. Results: All patients were ANA positive, CCP negative and female. At baseline, 15/20 had clinical synovitis. The others had either ultrasound synovitis (GS in 18/20, PD in 17/20) or >60 min EMS. 19/20 patients scored 4 points on SLEDAI for musculoskeletal involvement, BILAG scores were A in 7/20, B in 8/20, and C in 5/20. MSK-SLEDAI score improved in 9/20 at 4 weeks, MSK-BILAG improved in 16/20. For changes, see table 1. Conclusions: In MSK-SLE, ultrasound was the variable most consistently sensitive to change. All commonly used clinical variables significantly improved by week 4 but there was variation in responsiveness between them. BILAG-2004 and physician VAS had similar responsiveness to ultrasound. SRI-4 underestimated response, with substantial objective improvements in synovitis in SRI-4 non-responders. Developing organ-specific outcome measures may improve the ability to measure treatment effects in SLE clinical trials. Disclosure of Interest: None declared