AB0792 IMAGING METHODS IN PREDICTING A RADIOLOGIC PROGRESSION IN RA
Authors: O. Alekseeva, D. Kudinsky, A. Smirnov, A. Volkov, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2021)

Background: Rheumatoid arthritis (RA) is the chronic inflammatory joint disease, and it is responsible for structural damage. Several studies have shown that ACPA + patients were more likely than ACPA− patients to develop erosive changes on radiography. Ultrasound (US) is a well-established method of diagnosis and follow-up in RA, which at the moment may have a prognostic value in assessing the outcomes of the disease. Objectives: to identify the prognostic role of US in radiologic progression in RA patients. Methods: 85 RA pts, mean age 53,0 [44,0; 61,0] yrs, mean disease duration 8 [4; 24] months were treated with MTX and biologics according to Treat-To-Target concept. Among them 56 patients with early RA, mean age 53,5 [45,5; 61,0], disease duration 5 [3; 7,5] months. Hands and feet ultrasound (US) with gray scale (GS), power Doppler (PD) and destructive changes (erosion), according to the criteria of OMERACT, were analyzed before initiation of treatment and in 3, 6, 9 and 12 months after. A binary scoring system (presence/absence of erosions) of the joints examined was used. Radiographs were obtained at baseline and 4 years, radiographic changes were assessed using Sharp/van der Heijde modified scoring method. Radiographic progression was documented based on Sharp/Van der Heijde modified score changes during the follow up. Results: 71 ACPA+ (84%) and 14 ACPA− (16%) patients presented among the 85 patients with RA, among them 49 ACPA+ (87%) and 7 ACPA− (13%) with early RA. RA progression by 4 years the follow-up period was identified in 39% of pts. During the follow-up period 33 of 85 patients had radiographic progression: the count of erosion increased from 0 [0; 3] to 2 [0; 6]. At the same time, on the background of therapy, a decrease in ultrasound signs of inflammation was determined according to the GS and PD: from 6 [4; 9] to 1 [0; 2] p = 0.000 and from 2 [1; 6] to 0 [0; 1] p = 0.000, respectively, and increase in the number of joints with erosions (from 1 [0; 2] to 2 [0; 4], p = 0.000). In the group with early RA, the changes were similar. In ACPA+ general group the count of erosion at 4 years was significantly higher than in ACPA− general group (3 [0; 7] and 0 [0; 1], respectively, p=0.0026). In ACPA+ early RA group the number of joints with erosions by US at baseline was significantly higher than in ACPA− early RA group (1 [0; 1] and 0 [0; 0], respectively, p=0.017). In ACPA+ early RA group the count of erosion at 4 years was significantly higher than in ACPA− early RA group (2 [0; 4] and 0 [0; 0], respectively, p=0.009) (Table 1) Table 1. Characteristic of the groups (general group) at baseline ACPA+(71 pts ) ACPA- (14 pts ) p The number of joints with erosions by US 1 [0; 2] 0 [0; 1] 0,36 The number of erosions by X-ray 1 [0; 4] 0 [0; 1] 0,06 after 4 years follow up The number of joints with erosions by US 2 [0; 4] 1 [0; 2] 0,16 The number of erosions by X-ray 3 [0; 7] 0 [0; 1] 0,0026 Characteristic of the groups (early RA group) at baseline ACPA+(49 pts ) ACPA- (7 pts ) p The number of joints with erosions by US 1 [0; 1] 0 [0; 0] 0,017 The number of erosions by X-ray 0 [0; 2] 0 [0; 0] 0,11 after 4 years follow up The number of joints with erosions by US 2 [0; 3] 1 [0; 1] 0,22 The number of erosions by X-ray 2 [0; 4] 0 [0; 0] 0,009 Conclusion: Thus, in early RA is advisable to perform an US of the hands and feet to select a group of patients with potentially rapid radiological progression. US evaluation of patients with non-early stage RA is not very important for assessing the prognosis. Disclosure of Interests: None declared