FRI0123 Are there factors influencing the clinical vs ultrasound agreement in rheumatoid arthritis?
Authors: M. Le Boedec, S. Jousse-Joulin, J.-F. Ferlet, T. Marhadour, G. Chales, L. Grange, C. Hacquard-Bouder, D. Loeuille, J. Sellam, J.-D. Albert, J. Bentin, I. Chary-Valckenaere, M.-A. D’Agostino, F. Etchepare, P. Gaudin, C. Hudry, M. Dougados, A. Saraux
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Objectives</h3> To evaluate agreement between clinical (C) and ultrasound (US) assessment of synovitis (B, D and B+D mode) in active rheumatoid arthritis (RA) before and after treatment by antiTNF, and then to study factors associated with a good agreement. <h3>Methods</h3> 76 active (necessitating an anti-TNF therapy) RA (1987 ACR criteria) patients have been included in a prospective, 2 year follow-up multicenter cohort. For each patient, 38 joints were evaluated (2 wrists, 2 elbows, 2 shoulders, 2 knees, 10 MCP, 10 PIP, 10 MTP). Synovitis grade was collected at baseline using a semi-quantitative variable for both the physical examination (from 0=definitively no synovitis to 3=yes obvious and important), US Grey Scale (GS) (from 0=absence of synovial thickening to 3=marked synovial thickening) and US Power Doppler (PD) (from 0=absence of signal, no intra-articular flow to 3=marked signal in more than half of the synovial area. The kappa coefficient was determined to evaluate the reliability of categorical variables (synovitis if grade ≥1). Factors associated with a good agreement were evaluated using both uni and multivariate analysis (all items statistically significant in univariate model and not correlated with other items were included). <h3>Results</h3> Concordance before anti TNF between C and US assessment (kappa -0.08 to 0.51) as well as agreement between B and D mode (0.30 to 0.67) were variable according to the evaluated joint site. C and US agreement was particularly low on MTP and shoulders (kappa&lt;0.3); they were excluded for the evaluation of factors associated with good C-US agreement. Practically all synovitis detected using D mode were also detected using B mode which was more sensible. Factors associated with good C-US agreement according to the multivariate analysis before anti TNF were: 1] B mode: low DAS 28, high physician VAS and positivity of rheumatoid factors (RF) 2] D mode: no semi recent evolution of RA (2-5 years), moderate activity of RA (DAS 3.2-5.1), age between 40-50 yrs and female sex. After anti TNF they were: 1] B mode: joint site (knees, elbows, MCP 4 and 5, IPP 2 to 5), male sex, low BMI, no semi recent evolution of RA (2-5 years), moderate disability on HAQ and low DAS 28. 2] D mode: joint site (knees, elbows, MCP 4 and 5, IPP 1 to 5), low BMI, recent evolution of RA, moderate disability on HAQ, low DAS 28, low physician VAS and positivity of rheumatoid factors (RF). <h3>Conclusions</h3> Agreement between C and US assessment is joint site dependent. C assessment underestimates particularly MTP and shoulder synovitis. Factors associated to a good agreement on the other sites are numerous and variable according to US mode (factors associated to C-US mode B and D good agreement are different) and treatment (joint site, HAQ, low BMI are associated to a good C-US agreement after but not before TNF therapy). <h3>Disclosure of Interest</h3> None Declared