SAT0650 Musculoskeletal ultrasound in first degree relatives of rheumatoid arthritis patients
Authors: E. Soliman
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Preclinical phase of rheumatoid arthritis (RA) is characterised by a state of autoimmunity and inflammation. MSUS is known for its ability to detect subclinical synovitis, but changes in first degree relatives (FDR) are not yet defined. <h3>Objectives</h3> To investigate the presence of abnormal MSUS findings in FDR of RA who are free of clinical disease. <h3>Methods</h3> Study included 20 RA patients, and 25 of their FDR without evidence of arthritis. All were subjected to full history taking with special emphasis on joint symptoms, and joint examination. Measurements of ESR, CRP, RF and anti-CCP were performed in all and MSUS scan using the 7 joint ultrasonography (US7) score<sup>1</sup> <h3>Results</h3> Mean age in FDR 33.1±13.4 years, and in RA was 39.50±13.43 years with a mean disease duration of 11.95±8.36 years. All RA (100%) had symmetrical, polyarthralgia and/or arthritis, mostly involving small joints of hands and feet. 8/25 FDR (32%) had arthralgia that included different joints. While 17/25 FDR (68%) were asymptomatic. None of FDR had arthritis as it was an exclusion criteria. MSUS findings were detected in 16/20 (80%) RA and in 10/25 (40%) FDR. Of whom 3/10 FDR (12%) had arthralgia and 7/10 (28%) were asymptomatic. Synovitis was the commonest MSUS finding in RA (n=16, 80%), and in their FDR (n=10, 40%). Tenosynovitis was present in 5 (25%) RA and only one (4%) FDR. Erosions were detected in 9 (45%) of RA and one (4%) FDR in the 2nd MCP. In RA the wrist was most common joint to be involved on MSUS (n=14,70%), followed by 2nd MCP and 2nd MTP joints in 11 (55%), 5th MTP joint in 8 (40%), 3rd MCP joint in 6 (30%), 2nd PIP joint in 4 (20%), with least involvement in the 3rd PIP joint in 3 (15%) of RA. In FDR the wrist was also the most commonly involved joint on MSUS and 2nd MTP joint in 6 (24%), followed by 2nd MCP joint in only 1 (4%). Whereas, the 3rd MCP, 2nd and 3rd PIPs and 5th MTP joints were spared. US7 score in RA and FDR are shown in table 1. US7 erosion score correlated significantly with disease duration in RA. Anti-CCP significantly correlated with all parameters of US7 and RF with the tenosynovitis GS (grey scale) score. While, in FDR there was no statistical significant correlation between US7 score with any of the inflammatory or seromarkers. <h3>Conclusions</h3> This study confirms the presence of inflammatory synovial changes in FDR of RA who are free of clinical disease. This strengthens the concept of FDR as pre-RA. US7 score is a useful screening tool to identify subclinical synovitis in at-risk individuals. While in RA, US7 score is significantly correlated to disease duration and autoantibodies. More long term studies on FDR are needed for establishing the predictive value of abnormal MSUS findings for the development of persistent arthritis. <h3>Reference</h3> [1] Backhaus M, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: A pilot project. Arthritis Care Res2009;61(9):1194–201. <h3>Disclosure of Interest</h3> None declared