AB0542 ULTRASOUND VS CLINICAL REMISSION IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS: CONCORDANCE AND RELATIONSHIP WITH THERAPY DISCONTINUATION
Authors: R. La Ferrara, F. G. Lazzaro, G. Alonzi, S. Fiore, G. Peluso, A. L. Fedele, M. A. D’ Agostino, A. Ortolan
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Clinical remission in Rheumatoid arthritis (RA) is evaluated by composite indices, combining clinical and laboratory assessment. However, clinical remission does not always correspond to US remission (USR), due to a higher sensitivity of US, but the significance of this discrepancy, especially relatively to treatment, is still undetermined. <h3>Objectives:</h3> To evaluate prevalence of USR and concordance with clinical remission in patients with early RA in "drug-free" or "on-treatment" clinical remission. <h3>Methods:</h3> A cross-sectional study including early RA patients in SDAI remission≥6 months was conducted. CDAI, DAS28, DAS44 and Boolean remission were also evaluated. Patients underwent B-mode and PD assessments of 42 joints and 20 tendons using a My Lab Omega ESAOTE ultrasound scanner with a linear probe frequency of 6-18 MH. Synovial hypertrophy (SH) and tenosynovitis (TS) were assessed by B-mode and power Doppler (PD) mode, and graded semi-quantitatively (0-3) using standardized scores. Four definitions of USR were examined: USR1: absence of SH, TS, and PD signal; USR2: SH ≤1 and PD=0; USR3: SH≤1 and PD≤1; USR4: PD negative. <h3>Results:</h3> Eighty patients were enrolled, mean age 49.7 ± 14.0 years, mean disease duration 5.3 ± 3.5 months (at symptoms onset). Among these, 15% were in drug-free remission, 61% in monotherapy with csDMARDs 61%, and 24% in combination therapy with csDMARDs+bDMARDs. Overall rates of clinical remission were 100%, 87%, 92%, 97% and 80% according to SDAI, CDAI, DAS28, DAS44 and ACR/EULAR Boolean criteria respectively. All of the drug-free patients were in remission according to all indice, while in on-treatment patients prevalence of clinical remission were as follows: 100%, for SDAI, and 81%, 90%, 96% and 76% for CDAI, DAS28, DAS44 and ACR/EULAR Boolean criteria. Regarding prevalence of USR, the overall rates were 68%, 88%, 88%, 90% for USR1, USR2, USR3 and USR4 respectively (Table 1). The rate of USR in drug-free vs on-treatment remission patients was 58%, 66%, 66%, 83% versus 70%, 87%, 89%, 91% for USR1, USR2, USR3 and USR4. <h3>Conclusion:</h3> Our study confirmed that concordance between clinical and US remission is greater when criteria for defining remission are more permissive. On-treatment patients (either with csDMARDs or bDMARDs) have a greater probability of being in clinical and USR than drug-free patients. This observation supports the hypothesis that continuation of therapy allows the achievement of both clinical and subclinical remission, the latest detected by US. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Raffaele La Ferrara: None declared, Federico Giuseppe Lazzaro: None declared, Gabriella Alonzi: None declared, Silvia Fiore: None declared, Giusy Peluso: None declared, Anna Laura Fedele†: None declared, Maria Antonietta D' Agostino Jannsen, Novartis, Abbvie, Jannsen, Novartis, Abbvie, Augusta Ortolan Janssen, Abbvie, Novartis, UCB.