AB0628 IMAGING FEATURES OF PATIENTS WITH LONG-TERM STRUCTURAL PROGRESSION STRUCTURAL PROGRESSION IN RHEUMATOID ARTHRITIS
Authors: K. Maatallah, C. Ines, H. Ferjani, F. Majdoub, D. Ben Nessib, L. Kharrat, D. Kaffel, W. Hamdi
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Baseline imaging findings in Rheumatoid Arthritis (RA) have been identified as significant predictors of structural progression over time. <h3>Objectives:</h3> To compare imaging features between progressors and non-progressors in RA. <h3>Methods:</h3> we conducted a retrospective cohort study. We included real-life RA patients with no pre-established treatment strategy, who have been or are still being followed in the Rheumatology Department of the Med Kassab Institute of Orthopedics for at least 5 years. For each patient, two check-up times were defined: T0 (baseline) and T1 (T0+X, X ranging from 5 to 12 years). Sonographic data (hand ultrasound: joint effusion, synovitis, power doppler and erosion scores were rated according to the binary mode: Yes/no) at T0 were extracted from medical records. Clinical, biological, radiographic (hand X-ray) and disease-related data were retrieved at both T0 and T1. Hand and wrist radiographs and hand and wrist ultrasounds were performed concomitantly or within a 6 months range. Our primary endpoint was the assessment of radiographic structural progression at T1. Thus, a validated score for assessing radiological changes was used: The modified SHARP score (encompassing joint space narrowing (JSN) score, erosion score and total sharp score). An associate professor with 15 years of expertise examined the radiographs randomly, without prior knowledge of clinical and ultrasound data. They were also blinded to the chronological order of the radiographs. A subset of 10 hand radiographs were read twice by the same examiner with good Intra-examiner reproducibility (ICC=0,96). As participants had varying durations of follow-up, time weighted delta sharp score was used. Structural progression was defined as an increase in the score of ≥5units/year from the baseline (Group 1 (G1): Progressors). Group 2 (G2) included patients defined as non-progressors with delta sharp score&lt;5units/year. Statistical analysis (univariate and multi-variate analysis) was performed to identify the relationship and correlations between structural progression and baseline imaging data. Area under the curve (AUC) was calculated for different variables to enhance the discernment of performance in discrimination. <h3>Results:</h3> Forty-three participants were eligible for this study with a sex-ratio=0.11 (100% female in G1 and 89,01% female in G2). Thirteen patients (23.26%) had a Δ Sharp ≥ 5 units/year. There was no statistically significant difference between both groups regarding gender, age, follow-up time and disease duration. Statistically significant differences were noted between both groups regarding radiographic and sonographic data at baseline. Baseline JSN sharp score was 56,70 and 18,72 in G1 and G2 respectively (p&lt;0,001). Baseline erosion sharp score was 31,2 and 8,27 in G1 and G2 respectively (p&lt;0,001). Baseline total sharp score was 87,90 and 27,00 (p&lt;0,001). Regarding baseline sonographic data, there was no difference between both groups in power Doppler score and erosion score (p=0,577 and p=0,637 respectively). However, G1 had higher baseline joint effusion scores (2,82 versus 1,60) and synovitis scores (7,40 versus 2,60) (p=0,017 and p=0,007). ROC curve analysis showed a significant association between disease structural progression and the baseline Sharp scores. The cumulative JSN Sharp score showed the highest AUC (0.956). The cut-off value for the cumulative JSN Sharp score was 33. A multivariate binomial logistic regression analysis was performed to identify factors independently associated with progression. Factors associated with progression were baseline Synovitis Score (IRR= 1.261; P=0.035), baseline joint effusion Score (IRR= 1.183; P=0.014), baseline JSN Sharp Score (IRR= 1.256; P=0.001), baseline Erosion Sharp Score (IRR= 1.192; P=0.002) and baseline Total Sharp Score (IRR= 1.267; P=0.001). <h3>Conclusion:</h3> Baseline sonographic data (joint effusion and synovitis score), sharp scores (JSN score, erosion score and total score) predicted structural progression in our study. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>