AB1174 IS MONITORING SYNOVITIS IN THE HANDS BY ULTRASOUND ENOUGH TO ASSESS TREATMENT EFFECT IN PATIENTS WITH RA IN CLINICAL PRACTICE?
Authors: Dolores Ramos-Bello, Hilde Berner Hammer, Mette BjØrndal Axelsen, Mikkel Ǿstergaard, Sin Ngai Ng, Merete L. Hetland, Susanne Juhl Pedersen, Lene Terslev
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The use of ultrasound (US) as a tool for assessing disease activity in patients with rheumatoid arthritis (RA) has increased in recent years and its value is supported by studies showing that US provides more accurate assessment of joint inflammation than clinical examination at time of diagnosis and in clinical state of remission. Various scoring systems have been proposed for monitoring of synovitis. Among these are the novel consensus-based Global OMERACT-EULAR Synovitis Score (GLOESS) was developed applying the highest score of grey-scale (GS) or Doppler as the final score for the joint. Different joint sets have been proposed for optimal and feasible evaluation of patients with inflammatory arthritis but currently there is no agreement on a specific reduced set of joints that should be evaluated by US to acquire the best information about clinical and subclinical activity when monitoring patients with RA. <h3>Objectives</h3> To evaluate if synovitis assessment of hands only is enough (testing GS, Doppler and GLOESS sum scores) for assessing changes during treatment in order to increase clinical feasibility of US in daily clinical practice. <h3>Methods</h3> US and clinical assessment for tender/swollen joint count (TJC/SJC) were performed in 19 patients fulfilling ACR 1987 criteria for RA initiating treatment with TNF inhibitor (TNFi) (week 0), and after 6 and 16 weeks of follow up. Forty-six joints were evaluated by US (sternoclavicular, acromioclavicular, glenohumeral, elbow, wrist, MCP1-5, PIP1-5, hip, knee, ankle and MTP 1-5 bilaterally) using a GE Logiq E9 machine with a linear array transducer. Joint inflammation was graded 0-3 on GS and Colour Doppler (CD) and synovitis was defined as a GS score &gt;1 with or without Doppler score &gt;1. Doppler settings for slow flow was applied according to guidelines. GS, CD and GLOESS sum scores were obtained for the total joint set and different joint subsets: hands as joint set (wrist, 1-5 MCP, 1-5 PIP bilaterally), 28 conventional joints evaluated for DAS and the 9-joint set suggested for the GLOESS (shoulder, elbow, wrist, MCP1 and 4, PIP2, MTP 3 and 5, knee). Data from the different joint sets were analyzed applying Spearman's correlation coefficient. <h3>Results</h3> Mean change in GS sum score between week 0 and 16 was of 2.58, 1.35, 1.47 and 1.11 for 46-joint set, hands, 28-joint set and 9-joint set, respectively. Compared to the 46 joint set the GS and CD sums core had a high correlation coefficient (&gt;0.78) for 28 joint set and the hand as joint set for all time points - table 1. The 9 joint set GS sum score had low correlation when compared to the 46 joint set at baseline and during follow up – table 1. GLOESS for the hands performed equally well with a correlation coefficient (&gt;0.70) for all joint sets at all time points – table 1. DAS28-CRP did not correlate with the total joint set or the different joint subsets. <h3>Conclusion</h3> The present study of patients with RA shows that the US examination of both hands only for assessing disease activity is highly correlated for with the 46-joint evaluation at all time points, both regarding GS and Doppler sum scores. Using hands as a reduced joint set US assessment of inflammation could be an option to increase the feasibility of US in routine clinical practice. <h3>Disclosure of Interests</h3> Dolores Ramos-Bello: None declared, Hilde Berner Hammer Grant/research support from: AbbVie, Pfizer and Roche, Paid instructor for: AbbVie, Pfizer, UCB, Novartis, Roche, Speakers bureau: AbbVie, Pfizer, UCB, Novartis, Roche, Mette BjØrndal Axelsen: None declared, Mikkel Ǿstergaard Grant/research support from: Abbvie, Celgene, Centocor, Merck, Novartis, Consultant for: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Sin Ngai Ng: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen, Pfizer, Consultant for: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck, Samsung Bioepis, Susanne Juhl Pedersen: None declared, Lene Terslev Speakers bureau: Speakers fee from : Roche, Novartis, Pfizer, MSD, BMS, Celgene