AB1119 U9: A NOVEL CLINICALLY ORIENTED ULTRASONOGRAPHIC SCALE AS A USEFUL MARKER FOR MONITORING THERAPEUTIC RESPONSE IN RHEUMATOID ARTHRITIS (MULTI CENTERS STUDY)
Authors: M. A. Mortada, H. Eitta, R. Elmallah, A. Radwan, A. Elsaman
Journal: Annals of the Rheumatic Diseases (2020)

Background: Musculoskeletal Ultrasonography (MSUS) is now a widely used tool for monitoring of rheumatoid arthritis (RA). Although there are many proposed sets of composite scores, a fixed set of joints may not be an ideal tool to assess a disease like RA, which affects many joints and tendons in different presentations. In previous study (1) U9 score was proven to be correlated with disease activity parameters. Objectives: To determine whether US assessment using U9 score is useful for monitoring response to treatment for RA or not? Methods: A prospective, multicenter study were conducted in period from July 2019 to December 2019. All recruited RA patients were subjected to: Disease activity assessment by clinical disease activity indices (CDAI and DAS28 ESR). Functional status assessment by (HAQ) and ultrasonographic assessment using U9 score which include 8 joints (bilateral wrists,2 nd MCP,3 RD MCP and knees) plus most clinically affected joint or tendon (one joint or one tendon). Most clinically affected joints from 48 joints. Any affected tendons could be choosing. All targeted joints were evaluated according to EULAR guidlines and by EULAR/ OMERACT combined score (0-3). Targeted tendons were scored (0-3).All patients received their treatment (biologic and non biologic DMARDs) according to the decision of the treating physicians. No specific therapy is needed. CDAI and DAS28 ESR, HAQ and U9 score were repeated after 3 months to detect the response to change after receiving the therapy. Results: One hundred and forty patients (23.6% were male) with mean age 39.26±11.30 were recruited from 4 tertiary referral university hospitals. There was a significant difference (&lt;0.001) between the first and second visits as regards clinical, laboratory and ultrasonographic parameters. DAS 28 decreased form (5.29±1.21) to (3.95±0.99), ESR decreased from (42.12±15.24) to (26.84±12.32), HAQ2 improved from (0.652±0.350) to (0.510±0.237) and U9 total US score decreased from (13.56±5.18) to (8.02±4.28). There was significant correlation between U9 ultrasonographic score and clinical parameters at both visits (table 1). Table 1. correlation between U9 ultrasonographic score and clinical parameters. U9 at 1 st visit U9 at 2 nd visit DAS-28 Pearson Correlation (P value) 0.806 &lt;0.001 0.790 &lt;0.001 CDAI Pearson Correlation (P value) 0.787 &lt;0.001 0.773 &lt;0.001 HAQ Pearson Correlation (P value) 0.431 &lt;0.001 0.317 &lt;0.001 We found that the most suitable cut-off value of U9 score to predict high disease activity was 11.5 (sensitivity 85.7% and specificity 80.6%), cut off value for moderate disease activity was 5.5(sensitivity 83.2% and specificity 88%) and cut off value for low disease activity was 3.5 (sensitivity of 83.3% and specificity 57.1%). These results are summarized in the following table: Conclusion: U9 ultrasonographic score is very useful method for evaluating the monitoring the response of treatment. References: [1]Mortada, et al. Annals of the Rheumatic Diseases 2019;78:1009. Disclosure of Interests: None declared