AB1117 CLINICAL IMPACT OF MUSCULOSKELETAL ULTRASOUND ON RHEUMATOID ARTHRITIS IN ROUTINE CLINICAL PRACTICE
Authors: J. Molina Collada, M. Pérez, I. Castrejon, J. C. Nieto, T. González, J. Rivera, C. Gonzalez, I. Monteagudo, J. M. Alvaro-Gracia
Journal: Annals of the Rheumatic Diseases (2020)

Background: Musculoskeletal ultrasound (MSUS) is a useful tool to assess disease activity in rheumatoid arthritis (RA) patients. However, it has not yet been established if its use would change treatment decisions within a treat to target strategy or whether it would lead to better outcomes in RA patients Objectives: Our aim was to determine the impact of MSUS in the clinical management of RA patients and investigate factors associated with subsequent clinical actions by the referring rheumatologist Methods: A prospective analysis of RA patients seen at an MSUS clinic over a 6-month period was undertaken. Pre- and post-US follow-up data (± 3 months) were analyzed. Baseline assessment included clinical features, physical examination and laboratory tests. All MSUS examinations were performed according to EULAR guidelines and using an Esaote MyLab 8 (Esaote, Genoa) with a high frequency (8-15 MHz) transducer. Patients were stratified in groups based on the clinical impact of the MSUS visit: 1) No clinical impact and 2) US findings leading to subsequent clinical action by the referring rheumatologist (including changes in dosages of current rheumatologic treatments, addition/substraction of medications or interventional procedures based on the MSUS results). First, differences between groups were tested using chi-squared and Student-t tests in the univariate analysis. Second, multivariate logistic regression models were employed to investigate factors associated to a change in clinical management Results: A total of 61 RA patients were included for analysis. Mean age was 61.9± 11.4 years and 51 (83.6%) were female. Disease activity assessment was the most frequent referral reason (43; 70.5%). Overall, MSUS led to a subsequent therapeutic action by the referring rheumatologist in 39 (63.9%) patients, and to a change in the underlying diagnosis and/or in the clinical impression of the chief complaint that generated the referral in 7 (11.5%) patients. Baseline characteristics between both groups are compared in Table 1. In the univariate analysis, the detection of Power Doppler (PD) synovitis/tenosynovitis and 28 swollen joint count were significantly associated with a subsequent clinical action. In the multivariate analysis only PD synovitis/tenosynovitis (OR=3.28; 95%CI 1.06-10.27) remained significantly associated with a change in clinical management (Table 2) Table 1. Baseline characteristics of RA patients Total n= 61 Change in clinical management n= 39 (63.9%) No change in clinical management n= 22 (36.1%) p Age 61.9±11.4 61.5±12.5 62.6±9.2 0.7 Sex Female 51(83.6%) 35(89.7%) 16(72.7%) 0.09 Smoking Non smoker 33(54.1%) 17(43.6%) 16(72.7%) 0.08 Smoker 13(21.3%) 11(28.2%) 2(9.1%) Former smoker 15(24.6%) 11(28.2%) 13(21.3%) Radiographic erosions 29(48.3%) 22(57.9%) 7(31.8%) 0.05 28 Tender Joint Count 2.3±3.4 2.7±3.9 1.6±2.4 0.2 28 Swollen Joint Count 2±3 2.6±3.5 1.1±1.6 &lt;0.05 ESR (mm/h) 28.1±20.6 26.1±15.5 31.7±27.4 0.4 CRP (g/L) 1±1.5 1±1.4 0.9±1.7 0.7 RF (IU/mL) 175.8±452.8 139.9±249.5 243.9±697.4 0.4 ACPA (IU/mL) 775.6±998.6 619.4±797.1 1079.9±1,275.9 0.2 US PD synovitis/tenosynovitis 37(60.7%) 28(71.8%) 9(40.9%) &lt;0.05 Table 2. Independent factors associated with a change in clinical management based on logistic regression model p Odds ratio 95% C.I. Lower Upper 28 Tender Joint Count 0.13 1.24 0.94 1.64 US PD synovitis/tenosynovitis 0.04 3.28 1.06 10.17 Conclusion: The most common indication of MSUS examination in RA patients was disease activity assessment. MSUS findings led frequent changes in therapeutic management and even to a change in the diagnosis in some of cases. The presence of PD synovitis/tenosynovitis was significantly associated to a change in the therapeutic management. These data highlight the impact of MSUS inflammatory findings in RA patients in daily clinical practice Disclosure of Interests: Juan Molina Collada: None declared, María Pérez: None declared, Isabel Castrejon: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Teresa González: None declared, Javier Rivera: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Indalecio Monteagudo: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB