FRI0276 Ultrasonography as Useful Tool to Identify Rheumatoid Arthritis Patients in Clinical Remission for Tapering or Withdrawal TNFA Blockers without Disease Relapse
Authors: S. Alivernini, G. Peluso, M. Correra, A.L. Fedele, E. Gremese, G. Ferraccioli
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Ultrasonography (US) has superior sensitivity in detecting the presence of synovial hypertrophy (SH) and its activity by Power Doppler (PD) in Rheumatoid Arthritis (RA). The relapse rate is nearly 50% after biologic treatment withdrawal due to disease clinical remission. <h3>Objectives</h3> The aims of the study were to assess the US SH rate in a cohort of RA patients in clinical remission who tapered first and stopped thereafter anti-TNFα treatment and to evaluate if US characteristic (SH thickening rate) could predict any clinical relapse. <h3>Methods</h3> 49 RA patients in clinical remission (DAS&lt;1,6) underwent baseline US evaluation (dorsal and volar view scanning of II-III MCP and II-III PIP bilaterally, wrists, knees and II-V MTP bilaterally). At baseline, RA patients were stratified into 2 subgroups as SH+/PD- and SH+/PD+, based on US characteristics. SH+/PD- patients tapered anti-TNFα treatment (Adalimumab 40 mg/monthly or Etanercept 50 mg/2 weeks) for 3 months. After biologic tapering, RA patients who were still PD-, stopped biologic and were followed for at least 3 months, maintaining only DMARDs. Treatment modifications were not allowed during the study. Relapse rate was recorded for each patient (DDAS &gt;1,2 from the DAS value at the time of last US assessment). <h3>Results</h3> At the study entry, 7 (14,3%) RA patients were SH+/PD+ whereas 42 (85,7%) patients were SH+/PD- and tapered the biologic. No patients were SH-/PD-. After 3 months tapering, 13 (30,9%) RA patients showed disease relapse. RA patients who relapsed, did not differ for anti-CCP (p=0,85), IgA-RF (p=0,25) and IgM-RF (p=0,51) positivity, smoking habit (p=0,47) and biologic type (p=0,69) from RA patients who did not relapse. However, significantly higher SH thickening values in MCP and MTP at baseline characterized RA patients who relapsed after 3 months tapering, compared to RA patients who did not (0,46±0,18mm vs 0,59±0,14mm for MCP and 0,36±0,22mm vs 0,65±0,44mm for MTP; p=0,05 and p=0,01 respectively). To date, among RA patients who did not relapse after tapering, 20 (70,0%) RA patients stopped biologic. After biologic withdrawal, 4 (20,0%) RA patients showed disease relapse after 3, 6, 7 and 9 months respectively. All RA patients who relapsed had disease flare in the joint site, clinically involved at the time of the disease onset (80% in the MCP and 20,0% in the knees). RA patients who relapsed did not differ for the previous demographic and immunological parameters as well as for the biologic type (16,7% of Adalimumab treated vs 25,0% of Etanercept treated patients have disease flare;p=0,65). However, SH thickening rate in MTP was found higher in RA patients who relapsed after biologic stopping (0,66±0,42mm) than who did not (0,38±0,21mm;p=0,04). Finally, all RA patients who relapsed were newly treated with the previous biologic, following the last effective therapeutic regimen. <h3>Conclusions</h3> US based patients selection before treatment tapering and/or stopping is a useful tool to minimize disease relapse rate. Drug free remission is a possible goal in the majority RA patients without synovial tissue activity signal, with no difference between anti-TNF-α agents. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.4474