AB1097 THE ASSOCIATION OF ULTRASOUND ASSESSMENT AND PATIENT REPORTED OUTCOMES IN RHEUMATOID ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW
Authors: T. Gudu, M. A. D’agostino
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patient reported outcomes (PROs) are recognized to be essential outcome measures in the assessment of patients with rheumatoid arthritis (RA), but they can be prone to being influenced by multiple variables. Thus, objective measures of disease activity, i.e. imaging techniques such as musculoskeletal ultrasound (US) are also of great interest. Objectives: The objective of this study was to determine if and to which extent the US assessment reflects patient perspective in patients with RA. Methods: A systematic literature review was conducted on PubMed and Embase, with the research question being formulated according to the PICO framework. The patient reported domains of health were selected from the ones included in the Core Set for RA [1] and from the ones frequently reported in RA clinical trials and observational studies [2], as well as patient self-assessment of pain or functionality at the joint level. We included articles that evaluated any kind of relationship between PROs and US assessment in RA patients. Results: Out of the 3757 abstracts identified through the systematic literature review, 53 articles were finally included in the qualitative analysis, of which 38 were cross-sectional and 15 were longitudinal studies (figure 1). The most frequently evaluated domains are depicted in table 1. Domain Studies reporting the domain N (%) out of 53 articles Function/ disability 37 (69.8) Pain 25 (47.2) Patient global assessment 21 (39.6) Morning stiffness 14 (26.4) Quality of life 5 (9.4) Global or general health/ well-being 5 (9.4) Fatigue 4 (7.5) Disease activity 1 (1.9) Mood disorders (anxiety/ depression) 1 (1.9) Treatment adherence 1 (1.9) Disease impact 1 (1.9) Foot impact (impairment and participation restriction) 1 (1.9) Pain catastrophizing 1 (1.9) Table 1. Patient reported domains evaluated in the included studies. Figure 1. Flow chart of the systematic literature review Cross-sectional studies : Overall, patient joint self-assessment of joint swelling or tenderness had a rather poor agreement with US evaluation but showed a stronger association with the clinical examination at the joint and/ or patient level. In studies evaluating RA patients in remission, disability and patient global assessment (PGA) were associated with Power Doppler (PD) synovitis (r= −0.395 to -0.460), while morning stiffness and patient assessment of flare with PD tenosynovitis (r= 0.29; odds ratio, OR 1.95 [95% CI, 1.17, 3.26]). In studies on RA disease activity, morning stiffness showed good associations with US inflammatory findings, especially PD tenosynovitis (r=0.280 – 0.561; OR 3.0 [95% CI, 1.2-7.5] or OR 10.9 [95% CI,1.2–39.13]) and disability with PD synovitis/ tenosynovitis (r=0.14 -0.55) and US damage/erosions (r=0.16-0.40). Pain, PGA and quality of life (QoL) mainly did not correlate with US assessment. Longitudinal studies : In total, there was no clear, consistent longitudinal association between PROs and US variables in RA studies on remission or treatment response. However, in studies on RA disease activity, there was a strong longitudinal association between disability and US inflammatory scores (r= 0.32 – 0.40; beta: -0.009 to -0.025), but not US damage scores. Additionally, US ankle synovitis and/or tenosynovitis were shown to predict ankle pain (beta: 16.8 [95% CI: 4.81, 28.8]), and to a lesser extent disability. Conclusion: Overall, we found contradictory results regarding the relationship between US evaluation and PROs in RA. While there were some consistent associations such as between disability and US inflammatory and structural findings or between MS and US inflammatory lesions, in particular tenosynovitis, there was no global strong correlation between US and PROs. Therefore, both assessments should be taken into consideration in RA evaluation and management. References: [1]Felson, AR 1993 [2]Orbai, Curr Rheumatol Rep 2015 Disclosure of Interests: None declared