THU0614 FINGER EXTENSOR TENDON INVOLVEMENT IS FREQUENT IN EARLY RHEUMATOID ARTHRITIS
Authors: Mihaela Maruseac, Adrien Nzeusseu, Maria Stoenoiu
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Finger extensor tendon (FET) involvement at ultrasound examination (US) was previously described in patients suffering from early and established psoriatic arthritis<sup>1</sup>. The reliability of the US measure of FET was as least as good as for synovitis<sup>2</sup>. The involvement of the FET in patients suffering from rheumatoid arthritis remains controversial. <h3>Objectives:</h3> To assess the involvement of FET in early rheumatoid arthritis (ERA) patients and in asymptomatic subjects (CTR). <h3>Methods:</h3> Inclusion criteria for ERA patients were: less than 6 months since the ERA diagnosis; age &gt;18 years; without DMARD treatment or oral glucorticoid treatment. Inclusion criteria for CTRL subjects were : age &gt;18 years; no pain in hands and fingers (VAS pain =0/100); no known rheumatic disease such a systemic diseases, rheumatoid, psoriatic arthritis, spondyloarthritis, hand osteoarthritis, gout, chondrocalcinosis; no psoriasis, no inflammatory bowel diseases. US assessments were performed blindly to the clinical and laboratory data. FET were assessed in longitudinal and in transverse view at the metacarpo phalangeal joint (MCP) and proximal phalangeal joint (PIP) level both in grey-scale (GS), power Doppler (PD) and in color Doppler (CD) mode. In addition the following joints were assessed for the presence and grade (0-3 according to OMERACT definitions) for both GS and PD synovitis: wrists, ankles, metatarsophalangeal (MTP) (2-5) and MCP (1-5) joints. <h3>Results:</h3> Sixty-two consecutive ERA patients and 34 CTR were included in this study. Mean age and gender distribution were comparable between ERA and CTR (47,3±14,5 vs. 43,4±12,5). ACPA were present in 61%, rheumatoid factor in 54%, and bone erosions in 27% of ERA patients. 57% of ERA patients presented with FET and 0% of CTR (p&lt;0.001). The delay between the first symptom and diagnosis, the DAS28CRP, SDAI, CDAI, CRP level, 44TJC, 44SJC, HAQ did not differ significantly between patients with FET involvement and those without. In univariate analysis, the presence of FET involvement was significantly associated with the presence of bone erosions (p=0.02), ACPA (p=0.002), rheumatoid factor (p=0.02) and tobacco use (p=0.02). In multivariate analysis, the presence of FET involvement was significantly associated with the presence of bone erosions (p=0.01), ACPA (p=0.001), RF (p&lt;0.01). <h3>Conclusion:</h3> FET is relatively frequent in ERA patients and it is not present in asymptomatic subjects. Our results show that FET involvement is associated with the presence of ACPA, rheumatoid factor and bone erosions, thus identifying patients with possibly more aggressive or severe disease at baseline. <h3>References:</h3> [1] Wiell C, Szkudlarek M, Hasselquist M, Møller JM, Vestergaard A, Nørregaard J, Terslev L, Østergaard. Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis Arthritis Res Ther. 2007;9(6):R119. [2] Macía-Villa C, Falcao S, Gutierrez M, Medina J, Hammer HB, De Miguel E. What is metacarpophalangeal joint swelling in psoriatic arthritis? Ultrasound findings and reliability assessment. Clin Exp Rheumatol. 2018;36(5):896-899. <h3>Disclosure of Interests:</h3> Mihaela Maruseac: None declared, Adrien Nzeusseu: None declared, Maria Stoenoiu Grant/research support from: Abbvie, Roche, Wyeth