SAT0630 Agreement between patient-reported swollen and tender joints, clinical examination and synovitis detected by ultrasonography in rheumatoid arthritispatients at the time of patient-reported flare
Authors: D. Kuettel, L. Terslev, U. Weber, M. Østergaard, J. Primdahl, R. Petersen, M.A. Danielsen, K. Hørslev-Petersen
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> In Rheumatoid Arthritis (RA), patient-reported tender joints (PrTJ) correlate better with clinical examination than patient-reported swollen joints (PrSJ).<sup>1</sup> Clinical examination has inferior sensitivity to detect synovitis compared to ultrasonography (US).<sup>2</sup> However, data is sparse about these findings at the time of patient-reported flare (PRFl). <h3>Objectives</h3> To investigate agreement between PrSJ, PrTJ, clinically detected swollen and tender joints (cSJ and cTJ,) and inflammation by Colour Doppler (CD) US in RA patients at the time of PRFl. <h3>Methods</h3> 80 consecutive rheumatoid-factor and/or anti-cyclic citrullinated peptide antibody positive RA patients with DAS28-CRP&lt;3.2 and no swollen joints at baseline were during a one-year follow-up period requested to contact the hospital in case of a hand flare according to patients' perspective. At the flare visit, patients indicated PrSJ and PrTJ, and underwent examination for cSJ and cTJ, and US of bilateral wrists (wrist joints and six extensor tendon compartments), 1–5 metacarpophalangeal joints (MCP) and 1–5 proximal interphalangeal joints (PIP). CD synovitis and tenosynovitis were graded 0–3 according to EULAR/OMERACT scoring system<sup>3</sup> and joints and tendon sheaths with CD ≥1 were considered positive. Percentage agreement and Cohen's kappa were calculated between PrSJ, PrTJ, cSJ, cTJ and CD in joints and tendon sheaths. <h3>Results</h3> Thirty-six percent (29/80) of the RA patients reported a hand flare (69% female, mean age 65 years, median DAS28-CRP 1.8, at baseline). At flare, mean (±SD) number of PrSJ, cSJ, PrTJ, cTJ and CD positive joints were 2.7 (2.86), 1.5 (1.02), 4 (3.04), 4 (3.46) and 1.8 (1.31), respectively. For swelling, there was slightly superior agreement with CD for cSJ than for PrSJ, except for wrist tenosynovitis where patients agreed more frequently with CD than clinical examination did (table 1). Highest percentage agreement was seen for PIP, followed by MCP. Agreement, as assessed by kappa, was poor to fair, ranging from −0.009 to 0.33. Swelling in MCP and PIP joints, by patients and clinicians, and swelling in the wrist by clinician showed better agreement with CD than tenderness did. <h3>Conclusions</h3> Thirty-six percent of the RA patients reported flares in the hand during one year follow-up. Numbers of joints affected by swelling, tenderness or positive CD sign were low. Limited concordance between US, patient-reports and clinical examination suggests that these domains reflect different and potentially complementary aspects of inflammation in patient-reported flare. <h3>References</h3> [1] Cheung PP, et al. Arthritis Care Res2010;62:1112. [2] Naredo E, et al. Ann Rheum Dis2005;64:375. [3] Terslev L, et al. RMD Open2017;3: e00042. <h3>Acknowledgements</h3> The study was supported by a grant from the Danish Rheumatism Association, the University of Southern Denmark, the Region of Southern Denmark and Knud and Edith Eriksens' Commemorative Fund. <h3>Disclosure of Interest</h3> None declared