THU0119 COULD SYNOVITIS AND TENOSYNOVITIS DETECTED BY ULTRASOUND BE CONSIDERED A RISK FACTOR FOR SHORT-TERM FLARE IN RA PATIENTS IN CLINICAL REMISSION
Authors: J. Zacariaz H, M. Brom, F. Mollerach, J. Marin, L. Ferreyra G, J. Rosa, E. Soriano
Journal: Annals of the Rheumatic Diseases (2020)

Background: The clinical value of ultrasound (US) detected synovitis and tenosynovitis as predictors of flares in RA patients in clinical remission is not clear. Objectives: To investigate the value of US detected synovitis and tenosynovitis as risk factors for short term flare in RA patients in clinical remission. Methods: Consecutive RA patients in clinical remission (DAS28 ERS &lt; 2.6) for at least 3 months, underwent Power Doppler ultrasound (PDUS) examination of: 1st to 6th extensor compartments at the wrist, 2nd to 5th flexor, posterior tibial tendons and peroneals. Regarding joints, carpal joints, 1st to 5th MCP and 2nd to 5th interphalangeal proximal (IPP). Synovitis and tenosynovitis were defined according to OMERACT. Patients were followed for one year. Disease flare was defined as any increase of disease activity generating the need of change in therapy by the attending rheumatologist. Results: Ninety patients were included. Patients´ characteristics are shown in the table. After one year of follow-up, 26 patients (29%) experienced a flare. At baseline 39%, 23% and 8% had US detected synovitis, tenosynovitis or both respectively. The presence of US detected tenosynovitis (RR: 4.9; 95% CI: 2.2-10.8), but not of US detected synovitis (RR: 1.3; 95% CI: 0.76-2.2), showed an increased risk of having a flare. In the multivariable analysis, and after adjusting by age, gender, disease duration, DAS28, DMARDs and biologics use, and the US detected synovitis, only subclinical tenosynovitis (OR: 9.8 95% CI: 2.5-39.1; p=0.001) and baseline DAS28 (OR: 5.7, 95% CI: 1.1-31.6; p= 0.047) were significantly associated with an increased risk of flare. Conclusion: Subclinical tenosynovitis, but not synovitis, was associated with disease flare in patients with RA in clinical remission. This feature might have physio-pathological implications. References: [1]Filippou G, et al. The predictive role of ultrasound-detected tenosynovitis and joint synovitis for flare in patients with rheumatoid arthritis in stable remission. Results of an Italian multicentre study of the Italian Society for Rheumatology Group for Ultrasound: the STARTER study. Ann Rheum Dis 2018; 0 :1–7. doi: 10.1136/annrheumdis-2018-213217 [2]Bellis E, et al. Ultrasound-detected tenosynovitis independently associates with patient-reported flare in patients with rheumatoid arthritis in clinical remission: results from the observational study STARTER of the Italian Society for Rheumatology Rheumatology 2016; 55:1826_1836 doi: 10.1093/rheumatology/kew258. Advance Access publication 27 June 2016 Table 1. Demographic and clinical features from RA patients in clinical remission Feature Patients with flares (n=26) Patients without flares (n= 64) P value Mean age (SD) 63.1 (12.6) 57.5 (13.2) 0.0679 Females, n (%) 54 (84) 24 (92) 0.316 Mean Disease duration years (SD) 5.5 (5.5) 8.4 (5.9) 0.0344 Positive Rheumatoid Factor, n (%) 16 (61.5) 40 (62.5) 0.802 Mean Erythrosedimentation rate (ESR) 18.3 (8) 14.1 (10.4) 0.0680 Mean DAS28 ESR (SD) 1.9 (0.5) 2.2 (0.3) 0.0091 Mean Swollen joint count (SS) 0.15 (0.4) 0.15 (0.4) 0.9806 Mean Patient’s Global VAS (0-10) (SD) 1.4 (1.3) 1.1 (1.1) 0.2471 Mean tender joint count (SD) 0.2 (0.5) 0.2 (0.5) 0.9653 Treatment with DMARDs, n (%) 54 (81) 26 (100) 0.018 Treatment with biologics, n (%) 19 (30) 3 (11) 0.069 Disclosure of Interests: Johana Zacariaz H: None declared, martin brom: None declared, florencia mollerach: None declared, josefina marin: None declared, leandro ferreyra g: None declared, Javier Rosa Speakers bureau: ABBvie, Pfizer, BMS, Novartis, Janssen, Eli Lilly, enrique soriano Speakers bureau: Abbvie, Pfizer, BMS, Novartis, Janssen, Eli Lilly, UCB, Roche