SAT0633 Ultrasound predictive value in prearthritis. a prospective longitudinal study. (12th June 2018)

• Record Type: Journal Article
• Authors: Peiteado, D.; Monjo, I.; Nuño, L.; Villalba, A.; Miranda, M.E.; Fortea, P.; De Miguel, E.; Balsa, A.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 1168
• Page End: 1168
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.4853
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Inflammatory arthritis have a period of subclinical disease before the development of synovitis. It is necessary to know adequately the characteristics of this period to identify serological/imaging markers that recognise patients at risk of developing inflammatory arthritis. Objectives: To describe the clinical characteristics and ultrasound (US) findings in "pre-arthritis" phases. To investigate the association of the US parameters with clinical or laboratory parameters. Methods: Prospective longitudinal study of a cohort of patients with suspicious joint pain (predominance in nights or mornings, improving at day or with movement, or with morning stiffness >30′) of less than 1 year of evolution and involvement of at least one small joint of hands or feet. Patients with clear synovitis, previously treated with DMARDs/steroids, or those with a diagnosis of fibromyalgia or osteoarthritis were excluded. The number of painful and swollen joints (PJC, SJC) and laboratory parameters were evaluated. A blind and extensive ultrasound examination (US) was performed with a MyLabTwice (Esaote) equip with a 5–13 MHz probe for grayscale (GS) and Power Doppler (PD). We assess the presence of synovitis in GS, PD (0–3) and erosions in 36 joints (radio- Carpal, Inter-carpal, 1 st −5th MCP and IPP, 2nd −5th MTP, elbow, shoulder and knee bilaterally) and 14 tendon compartments (2nd, 4th, 6th wrist extensor tendon compartments, 3rd and 4th finger flexor tendons, posterior tibial and fibularis tendons). In addition, an overall score of EG and PD in the cohort is calculated. Statistics analysis was made by mean ±SD or median (IQR), and comparison was made by t- Student test (quantitative parameters) and non parametric test (qualitative) (p<0.05). Results: 20 patients were included, 95% women (60% non-smokers). Symptoms duration was 8±3 months. PJC median was 6 (RIC 2–9), without swollen joints in any case. ACPA and/or RF were positive in 6 patients (30%). ESR and/or RCP were elevated in 6 patients (30%). In the following 12 months, 45% of patients improved clinically, and 6 patients (30%) developed rheumatoid arthritis (RA). US results are exposed in the table 1, showing the number and percentage of patients with presence [≥1] of synovitis in GS, PD and erosions at different locations. The mean overall PD score was significantly higher in patients who will evolve to RA (9.1±2.8 vs 2.7±1.9, p<0.01) and in those with US erosions (10±1.4 vs 4.3±3.5, p<0.05). In addition, the mean overall GE score was higher in the RA group (9.1±2.8 vs 2.7±1.9, p<0.01) No significant differences were found between patients with or without acute phase reactants or positive RF/ACPA. Conclusions: In patients with pre-arthritis, Doppler scores were significantly higher among those with US erosions and those who evolve to RA. This results demonstrate the usefulness of US to predict the development of clinical arthritis in patients with inflammatory pain without synovitis Disclosure of Interest: None declared