SAT0093 THE ASSESSMENT OF THE SYNOVIAL VASCULARIZATIONWITH POWER DOPPLER ULTRASONOGRAPHY AND ITS CORRELATION WITH THE SYSTEMIC INDICATORS OF INFLAMMATION AND WITH THE DISEASE ACTIVITY
Authors: Michał Jakubaszek, Maria Maślińska, Mateusz Płaza, Małgorzata Mańczak, Brygida Kwiatkowska
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Rheumatoid arthritis (RA) is an autoimmune disease with the predominant synovial inflammation. The disease activity and inflammatory markers in the serum indicate an active stage of the disease with a risk of joint destruction. As the synovial hypervascularity is considered a proof of an active inflammation, its assessment with different scoring methods in Power Doppler ultrasonography (PDUS) is being discussed. <h3>Objectives:</h3> We investigated correlation of synovial vascularization (assessed in PDUS) with inflammatory markers and disease activity. We compared two methods for the evaluation of synovial vascularization : quantative and semi-quantitative. <h3>Methods:</h3> We studied 50 RA patients, mean age of 58 years, predominantly female (F/M ratio 3:1), mean disease duration span of 9,5 years. Data on: age, sex, patient global assessment of pain measured by a 100-mm visual analog scale (VAS) were obtained. The disease activity state was defined by DAS28 score (score in 28 joints) and simplified disease activity index (SDAI). Of the laboratory tests: erythrocyte sedimentation rate (ESR), serum C-reactive protein level (CRP), the presence of rheumatoid factor(RF) and anti–cyclic citrullinated peptide antibodies (ACPA) were performed. In ultrasound, the examination of the synovial vascularity, as a symptom of inflammation, was scored in PDUS, utilizing the validated scoring system, grade 0 – lack of flow, 1 – one to two vessels visible within the synovium, 2 – numerous vessels occupying up to 50% of the thickened synovium, 3 – numerous vessels occupying over 50% of the synovium volume. The second quantitatively scale was also used, with the color fraction index (CFI), defined as the ratio of the number of color pixels to all the pixels in a selected range of interest (ROI). The study was approved by the proper ethics committee. Statistical analysis: differences between groups were analyzed using U Mann-Whitney test (continuous variables). Correlations between quantative variables were assessed with the Spearman correlation coefficient. Statistical significance was set at p&lt;0.05. <h3>Results:</h3> DAS-28: mean 6.0 (SD=0.9); median 6.1 (IQR: 5.5 - 6.6); SDAI: mean 61.1 (SD=38.3); median 51.3 (36.8 - 76.4). No correlation was found between CFI and age, platelet count, CRP, RF, ACPA, DAS28 and SDAI as well as with the disease duration. But there was a strong positive correlation between CFI and PDUS results, rho = 0.71; p &lt; 0.05. As expected, DAS28 and SDAI strongly correlated with inflammatory markers (ESR, CRP). The results showed, that CFI between 2-8 % ia an equivalent of PDUS grade 1, CFI 8-50% of PDUS grade 2 and CFI &gt; 50% of PDUS grade 3. <h3>Conclusion:</h3> i)although PDUS is a method used to assess synovial inflammation, through the determination of the synovial vascularization, its results, regardless of the scoring system employed, do not correlate with the systemic inflammation indicators, such as ESR and CRP or with the disease activity – which needs further explanation, ii)the approximate equivalence of CFI and of PDUS scoring system is as follows: CFI &gt; 50% - PDUS grade 3, CFI 8-50% - PDUs grade 2, CFI&lt; 8% - PDUS 1, which confirms previously published research. <h3>Reference</h3> [1] Jindal S, et al. Gray Scale and Power Doppler Ultrasonographic Findings in the Assessment of Disease Activity and Their Correlation with Disease Activity Parameters in Rheumatoid Arthritis", Curr Rheumatol Rev (2018) 14: 153. 2. Schmidt WA, et al. Grading of ultrasound Doppler signals in synovitis: does it need an update? Rheumatology (Oxford). 2015;54(10):1897-903. <h3>Disclosure of Interests:</h3> None declared