AB0221 The use of ultrasound to identify disease activity in patients with rheumatoid arthritis in clinical remission or low disease activity in a real-life setting
Authors: E. Castillo, S. Farietta, D. Buitrago-Garcia, L. Villarreal, P. Santos-Moreno
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The goal of treatment in rheumatoid arthritis (RA) is to achieve remission or low disease activity for as long as possible, in order to prevent joint damage and loss of function. The evaluation and follow-up of disease activity relies on composite indexes with clinical outcomes. However, many studies have shown that a high proportion of patients categorised on remission or low disease activity by clinical methods could have disease activity by ultrasound (US).<sup>1</sup> <h3>Objectives</h3> The aim of this study was to evaluate disease activity by US in patients classified as to be in remission or in low disease activity disease activity by clinimetric evaluation. <h3>Methods</h3> We performed a cross-sectional study including patients with RA; Clinical follow-up was designed by the authors according to DAS28 as follows: every 3–5 weeks (DAS28 &gt;5.1), every 7–9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11–13 weeks (DAS28 &lt;3.1). Additionally the patient was evaluated by a rheumatologist expert in ultrasound; US studies were carried out with a Esaote MyLab Seven US equipment (Biomedica, Genoa, Italy) equipped with a 10–18 MHz linear transducer; PD was adjusted according to the following parameters: frequency, 8.0, PRF, 0.500, wall filter 3, gain between 50 and 70. The rheumatologist reported erosions, synovitis, osteophytes and power Doppler, we defined as active disease when patients had synovitis or positive power Doppler. We calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We performed a bivariate analysis using Pearson's Chi<sup>2</sup> <h3>Results</h3> We included 243 patients 64% were in remission and 36% in low disease activity, 85% were woman, mean age was 60 years±10. Mean DAS28 was 2.53%±0.53. 81% of patients received conventional DMARDs and 19% received biological DMARDS. The most frequent finding was erosions 70% in hands and 7% in feet followed by synovitis in hands 58%. See table 1. We found disease activity in 60% of our patients were 51% had positive Doppler and synovitis, 1% had only positive Doppler and 8% patients only had synovitis. We did not find statistical association between disease activity according to ultrasound and age, sex and type of pharmacological therapy in patients classified as to be in remission or LDA. <h3>Conclusions</h3> The evidence found in this real-life setting data, showed that two thirds of RA patients classified according to DAS28 to be in remission or LDA have subclinical disease activity; thus the ultrasound is a very useful tool to evaluate patients with RA in clinical practice. Further research is needed in order to identify the reasons of disease activity in patients were clinical findings point towards remission or LDA. <h3>Reference</h3> [1] Jeka S, Dura M, Zuchowski P, Zwierko B, Wojciechowski R. The role of ultrasonography in monitoring long-standing rheumatoid arthritis: a pilot study. Reumatologia2017;55(4):177–82. <h3>Disclosure of Interest</h3> None declared