AB0216 POWER DOPPLER SCORE IS USEFUL TO PREDICT JOINT DESTRUCTION OF HAND AND WRIST JOINT IN RHEUMATOID ARTHRITIS PATIENTS.
Authors: S. Okita, R. Nakahara, M. Matsuhashi, M. Watanabe, Y. Nasu, K. Nishida, T. Ozaki
Journal: Annals of the Rheumatic Diseases (2020)

Background: Several studies demonstrated that total power Doppler (PD) signal can predict radiographic progression as a change in total van der Heijde-modified total Sharp score (mTSS) in rheumatoid arthritis (RA) patients. However, in some studies, radiographic progression was observed in a different joint compared with the site of a positive PD signal at baseline in many cases. Objectives: The aim of this study was to identify the clinical factor of RA patients in association with radiographic progression of hands and wrists and to investigate which joint showed radiographic progression in RA patients. We focused on the correlation of the site of a positive PD signal and the site of radiographic progression. Methods: We examined retrospectively of 70 RA patients (67 women, three men) who underwent ultrasonography (US) examination at 32 regions on bilateral hands and wrists from 2014 to 2016. Radiographs of the hands were taken at baseline and at least one year after US (mean, 19.9 months), and radiographic progression was assessed using mTSS system. We performed multivariate logistic regression analysis to investigate the association between baseline factors and radiographic progression. The relationships between radiographic progression of the individual joint and total/each joint PD score were assessed by ROC analysis and Fisher’s exact test. Results: Nineteen patients (37.3%) experienced progression of mTSS of hands and wrists. DAS28-CRP (P=0.02) and total PD score (P=0.01) were associated with radiographic progression, and total PD score was significantly associated with radiographic progression (OR 1.22; 95% CI 1.04-1.36; P=0.006) by multivariate logistic regression analysis (Table 1). Table 1. Association between the demographic and clinical findings at baseline and radiographic progression over 12 months a.univariate analysis No radiographic progression (n = 51) Radiographic progression (n = 19) P-value Age, years 63.4 ± 12.7 58.1 ± 10.6 0.61 Duration of RA, years 24.4 ± 13.6 20.0 ± 5.0 0.28 Usage of Bio, % 42.2 40.4 0.57 Amount of MTX, mg/week 4.8 ± 3.3 4.5 ± 4.3 0.77 Amount of PSL, mg 1.5 ± 2.1 1.8 ± 2.2 0.73 DAS28-CRP 2.5 ± 0.7 2.9 ± 0.6 0.02* CRP, mg/dl 0.4 ± 0.5 0.7 ± 0.7 0.10 Total PD score 2.4 ± 3.3 6.6 ± 6.1 0.01* b.multivariate analysis odds ratio 95% CI P-value DAS28-CRP 1.63 0.72 - 3.71 0.238 Total PD score 1.19 1.04 - 1.36 0.010* Predictive performance of total PD score was good for radiographic progression of MCP joint (AUC-ROC 0.91) and wrist joint (AUC-ROC 0.85), although poor for PIP joint (AUC-ROC 0.57). PD score of wrist joint, MCP joint, and PIP joint were significantly associated with radiographic progression of each joint (P&lt;0.01). The sensitivity, specificity, positive predictive value, and negative predictive value of wrist joint PD score were 100%, 57.0%, 8.0%, and 100%, MCP joint PD score were 85.7%, 90.5%, 8.0%, 99.8%, and 8.3%, and PIP joint PD score were 30.0%, 97.2%, 13.6%, and 99.0%, respectively. Conclusion: Total PD score of hands and wrists was a strong predictor of radiographic progression, especially in MCP and wrist joint. Evaluation of PD signal in individual joint is a clinically useful method to predict radiographic progression of the same joint, however there are some differences in sensitivity and specificity. References: [1]Brown AK, et al. Arthritis &amp; Rheumatism. 2008;58:2958-2967. [2]McQueen F, et al. Annals of the Rheumatic Diseases. 2011;70:241-244. Disclosure of Interests: Shunji Okita: None declared, Ryuichi Nakahara: None declared, Minami Matsuhashi: None declared, Masahito Watanabe: None declared, Yoshihisa Nasu: None declared, Keiichiro Nishida Grant/research support from: K. Nishida has received scholarship donation from CHUGAI PHARMACEUTICAL Co., Eisai Co., Mitsubishi Tanabe Pharma and AbbVie GK., Speakers bureau: K. Nishida has received speaking fees from CHUGAI PHARMACEUTICAL Co., Eli Lilly, Janssen Pharmaceutical K.K., Eisai Co. and AYUMI Pharmaceutical Corporation., Toshifumi Ozaki: None declared