SAT0548 TRACKING RESIDUAL INFLAMMATION USING ULTRASONOGRAPHY IN PATIENTS WITH RHEUMATOID ARTHRITIS IN CLINICAL REMISSION
Authors: Saoussen Miladi, Myriam Moalla, Alia Fazaa, Kmar Ouenniche, Leila Souabni, Selma Kassab, Selma Chekili, Zakraoui Leith, Kawther Ben Abdelghani, Ahmed Laatar
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> With current treatment strategies, achieving a state of remission has become a realistic goal in rheumatoid arthritis (RA). Several composite scores and indices are available to assess remission based on clinical and biological parameters. None of the European League Against Rheumatism or American College of Rheumatology current recommendations include ultrasonography (US) findings as a parameter to define whether or not a patient is in remission. <h3>Objectives:</h3> Describe and compare clinical and ultrasonographic findings in RA patients in clinical remission. <h3>Methods:</h3> We included RA patients who were in clinical remission by the Disease Activity Score (DAS28&lt;2,6) for at least three months. B mode and Power Doppler (PD) US examination were performed by an experienced rheumatologist, blinded to clinical data. Twenty-two joints of both hands (wrists, metacarpo-phalangeal (MCP) and proximal interphalangeal joints (PIP)) were assessed. A binary score (absence or presence) of synovial hypertrophy/effusion (SH) and power Doppler (PD) signals was applied for each joint. The sonographic Remission was defined by the absence of PD signals. <h3>Results:</h3> Thirty patients were recruited (25 female and 5 male). The mean age of our population was 48 ± 8,98 years-old. All patients were in remission according to DAS28. The mean DAS28 was 2,03 ± 0,40 ranged from 1,13 to 2,6. Average length of remission was 16 months [3-72 months]. On clinical examination, nine swollen joints were identified, represented by wrists in all cases. On B mode, synovial hypertrophy was detected in 80% of patients. Among the 660 joints examined, synovitis was identified in 89 cases. A wrist synovitis was detected in 55% of cases (33 out of 60 wrists studied) making it the most affected joint, followed by the second and third PIP in 14 and 12 cases out of 60 studied, respectively [Table 1]. PD signal, as a sign of active disease, was observed in 78% of patients and detected in 43% of the total wrists examined (26/60) [Table 1]. Among the swollen joints found on clinical examination, only one had no synovial hypertrophy in B mode. However, subclinical synovitis was detected in 81 joints (12% of total joints) with predilection for PIP joints (47% of subclinical synovitis). In PD mode and among subclinical synovitis, PD signals were found in 38 joints (47%). Thus, the sensitivity of the clinical examination to identify swollen joints compared to US was 9%, its specificity of 99%, its PPV of 89% and its VPN of 88%. <h3>Conclusion:</h3> Subclinical joint inflammation detected by US might explain the structural deterioration in RA patients despite clinical remission. Our findings support the use of US for the accurate evaluation of disease status before concluding to remission or otherwise to adjust treatment. <h3>References</h3> [1] Karimzadeh H, Karami M, Bazgir N, Karimifar M, Yadegarfar G, Mohammadzadeh Z. Ultrasonographic findings of rheumatoid arthritis patients who are in clinical remission. J Res Med Sci. 2018;23:38. Published 2018Apr26. [2] E Naredo, L Valor,I De la Torre,J Martínez-Barrio, M Hinojosa F Aramburu et al,Ultrasound Joint Inflammation in Rheumatoid Arthritis in Clinical Remission: How Many and Which Joints Should Be Assessed?.Rheumatoid Arthritis Vol65, Issue4 Apr 2013: 512-517 <h3>Disclosure of Interests:</h3> None declared