AB0215 EARLY IMPROVEMENT OF THE POWER DOPPLER SIGNAL CAN PREDICT TO CONTINUE THE BIOLOGICAL DMARDS AFTER 1 YEAR.

Background:In rheumatoid arthritis (RA), biologics treatment is one of the effective treatment options. On the other hand, the effects of biologics cannot be obtained satisfactorily in all patients, and there are some cases in which treatment is interrupted due to ineffective or adverse events. However, the useful predictive markers of the biologics have not been found in the early phase of treatment in RA. Recently, ultrasound (US) has played a role of sensitive imaging modality in the diagnosis and follow-up of patients with RA.Objectives:In this study, we investigated whether continuation of biologics treatment can be predicted by ultrasonographic findings in the early phase.Methods:Fifty-four RA patients who started the first biologics from September 2016 to December 2018 were included. All the patients were performed clinical examination, blood tests and US examination of hand and foot at baseline, 4, 12, 24, 36 and 52 weeks. US examination was performed on MCP joints, PIP joints, wrist and MTP joints.Results:Among 54 cases, 42 cases were able to continue treatment until one year later, and the continuation rate was 80.8%. Of the 12 patients who discontinued first biologics treatment, 5 were changes to other biologics due to inadequate response, 4 were their wishes, and 3 were adverse events. Multiple regression analysis was performed with treatment continuation as the dependent variable and improvement of CRP, MMP-3, DAS28-CRP, grayscale score and power Doppler score in 4 weeks as explanatory variables. Only improvement of power Doppler score was extracted as a significant predictor (p = 0.045). In the continuation group, the improvement of the power Doppler signal at week 4 was 36% compared with the baseline, compared with 10% in the discontinuation group.Conclusion:The early improvement of power Doppler signal in 4 weeks could be a predictive factor for the continuation of 1-year biological treatment.References:[1]Grassi W, Okano T, Di Geso L, Filippucci E. Imaging in rheumatoid arthritis: options, uses and optimization. Expert Rev Clin Immunol. 2015;11:1131-46.[2]Atzeni F, Talotta R, Masala IF, Bongiovanni S, Boccassini L, Sarzi-Puttini P. Biomarkers in Rheumatoid Arthritis. Isr Med Assoc J. 2017;19:512-6.Table 1.Multivariate regression analysis of predictive factors for continuation of biologics treatment in 1-year.Improvement ratio of 0 to 4 weeksbetaP valueCRP-0.1220.465MMP-30.2280.103DAS28 CRP0.2800.103Ultrasound grey scale score-0.3420.119Ultrasound power Doppler score0.4420.045Acknowledgments:We thank Emi Yamashita, Yuko Yoshida, Asami Fujii and Shingo Washida who performed ultrasound examination.Disclosure of Interests:Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Kenji Mamoto: None declared, Yutaro Yamada: None declared, Koji Mandai: None declared, Shohei Anno: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

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OP0172 The Presence and Intensity of Power Doppler Signal are not Modified by Time of Assessment: Data form Patients with Rheumatoid Arthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-eular.377 ◽

2013 ◽

Vol 72 (Suppl 3) ◽

pp. A111.1-A111

Author(s):

A. M. Bertoli ◽

M. J. Audisio ◽

G. E. Py ◽

I. Strusberg

Keyword(s):

Rheumatoid Arthritis ◽

Power Doppler ◽

Doppler Signal ◽

Assessment Data ◽

Data Form ◽

Power Doppler Signal

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SAT0592 Diurnal Variation of Power Doppler Signal in Metacarpophalangeal Joints of Patients with Rheumatoid Arthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-eular.5892 ◽

2015 ◽

Vol 74 (Suppl 2) ◽

pp. 876.1-876

Author(s):

M. Gutierrez ◽

S. Challal ◽

A. Ariani ◽

E. Minichiello ◽

M.-C. Boissier ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Diurnal Variation ◽

Power Doppler ◽

Doppler Signal ◽

Metacarpophalangeal Joints ◽

Power Doppler Signal

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Use of Power Doppler Ultrasound in Haemophilia Could Predict Early Relapse of Intra Articular Bleeding after Haemarthrosis: A Prospective Cohort of 27 Haemarthrosis Monitored By Articular Ultrasound

Blood ◽

10.1182/blood.v126.23.1086.1086 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1086-1086

Author(s):

Laurent Frenzel ◽

Stephanie Luzy ◽

Cecile Lozach ◽

Richard Delarue ◽

Olivier Hermine ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Physical Examination ◽

Synovial Membrane ◽

Power Doppler ◽

Doppler Signal ◽

Joint Effusion ◽

Clotting Factor ◽

Joint Mobility ◽

Early Relapse ◽

Power Doppler Signal

Abstract Introduction: Whereas prophylactic treatment with clotting factor has demonstrated superiority to prevent joint disease versus on-demand therapy in haemophilia, haemophilic arthropathy remains an important complication of the disease. Repetitive intra articular bleeding are directly correlated to this progressive joint destruction. In rheumatoid arthritis, the use of articular Ultrasound with Power Doppler (USPD) has demonstrated superiority to predict joint inflammation and destruction over clinical examination and biological tests. Intensity of PD ultrasound is correlate to tissue vascularisation. As hypervascularization of synovial membrane would be probably associated to occurrence of intra articular bleeding, we proposed to evaluate PD ultrasound of synovial membrane in haemophilia. after a joint haemorrhage to predict haemarthrosis relapse. Method: Patients with severe haemophilia A(HA), B (HB) or type 3 von Willebrand (vWD) disease with acute haemarthrosis were prospectively included in a monocentric study, from April 2013 and November 2014. All included patients were treated using complementary daily clotting factor substitution according to clinical context. Clinical and USPD examination of the bleeding joint were performed at diagnosis (week 0: W0), week 1 (W1), week 2 (W2), month 1 (M1), month 2 (M2) and month 6 (M6). Physical examination considered pain, swelling and joint mobility. USPD was performed by the same radiologist, experienced in musculoskeletal ultrasound, using General Electric LogiqE9 device, with a high frequency (6-15 MHz) linear probe (PRF = 0,8 MHz), considering joint effusion, synovial thickening, presence of Power Doppler signal and bone erosion. Results : 21 patients were included: 16 children and 5 adults (median of age: 11,4 years-old). 14 patients presented HA, 3 HB and 4 vWD. 6 of them had inhibitors against clotting factor (4 with HA and 2 with vWD). All patients were on prophylactic regimen. 27 haemarthrosis were evaluated: 17 elbows, 7 knees and 3 ankles. 5 relapses were observed (median of time: 53 days). 3 of them had inhibitors (3/5). Clinically, all patients had no more pain at W2, even in case of relapse. At W2, swelling joint and joint mobility were identical to those before hemarthrosis. USPD showed: - 20/22 joints without Power Doppler signal did not rebleed, - all rebleeding joints presented Power Doppler signal (5/5), - in patients with no relapse, Power Doppler signal mainly disappeared between W2 (8/16) and M1 (11/16), - at M6, 8/12 patients presented abnormal USPD finding (6/12 joint effusion, 8/12 synovial thickening) without clinical evidence of relapse. Conclusion: As yet demonstrated in rheumatoid arthritis, USPD seems more sensitive than physical examination and very useful to manage haemarthrosis. Without PD signal, the risk of early relapse seems to be very low. Moreover the presence of PD signal seems to be correlated with higher risk of relapse. These findings would lead to better support patients with PD signal in order to avoid relapse, especially from W2 until PD signal disappeared. Persistent PD signal could justify an intensification of the treatment. Further studies should be conducted to confirm these data. Disclosures No relevant conflicts of interest to declare.

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Power Doppler signal calibration in the finger joint between two models of ultrasound machine: a pilot study using a phantom and joints in patients with rheumatoid arthritis

Acta Radiologica ◽

10.1177/0284185116685923 ◽

2017 ◽

Vol 58 (10) ◽

pp. 1238-1244 ◽

Cited By ~ 4

Author(s):

Ryosuke Sakano ◽

Katsumi Saito ◽

Tamotsu Kamishima ◽

Mutsumi Nishida ◽

Tatsunori Horie ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Pilot Study ◽

Power Doppler ◽

Finger Joint ◽

Doppler Signal ◽

Ultrasound Machine ◽

Power Doppler Signal

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AB0158 COMPARISON OF CLINICAL EXAMINATION AND ULTRASOUND OF HAND AND WRIST JOINTS IN RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1922 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1106.1-1106

Author(s):

S. Bouden ◽

B. D. Siwar ◽

A. Ben Tekaya ◽

O. Saidane ◽

R. Tekaya ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Clinical Examination ◽

Disease Activity Score ◽

Power Doppler ◽

Doppler Signal ◽

Left Wrist ◽

The Mean ◽

The Right ◽

Power Doppler Signal

Background:Ultrasound (US) is an accessible and non-invasive tool to assess joint involvement in rheumatoid arthritis (RA). It is used for diagnostic and prognosis purposes and for following of RA patients by evaluating the disease activity and therefore the response to treatment.Objectives:This study investigates agreement between US of hand and wrist findings and the clinical examination and biological inflammatory parameters in RA patients.Methods:We performed a cross sectional study including patients responding to the ACR/EULAR 2010 criteria for RA diagnosis. We collected US findings assessing synovitis and doppler signal in wrist, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) articulations, and concomitant clinical examination assessing synovitis and pain in the same joints along with C reactive protein (CRP) levels and disease activity score (DAS28). The power Doppler US score (PDUS) from 6 simplified synovial sites (wrists, bilateral second and third MCP joints) was calculated [1].Results:Forty-three patients were included with 91.7% of women. The mean age was 62±12.95 years old. The mean age at diagnosis was 52±14.79 years with a mean disease evolution of 8±8.57 years. Rheumatoid factor and anti-citrullinated antibodies were positive in respectively 78% and 83.9% of cases.The mean disease activity (DAS28) was 1,52 with levels ranging from 1.5 to 7.33.Right wrist was the articulation in which US synovitis was most frequently detected (60.5% of patients), followed by the left wrist (53.5%). Power doppler signal was detected as frequently in the right as in the left wrist articulations (41.9%). Subsequently, clinical synovitis was most frequently detected in right and left wrist with 39,5% and 41,5% respectively. These joints were the most frequently painful, in 51.2% and 48.8% at right and left respectively.US synovitis of the first interphalangeal joint was found in only 2.3% and 4.7% in the right and left hand respectively, with positive power doppler signal in 2.3% of the patients in the same articulations.The overall agreement between US and clinical examination in detecting synovitis of wrist, MCP and PIP joints was of 67.3%. It was of 71.4% in wrists, 54.7% in MCP joints and 87% in PIP joints. This suggests the presence of infra-clinical synovitis. All sites combined, US synovitis were correlated to clinical synovitis (p=0.03).A positive correlation was found between PDUS from 6 simplified joint sites and CRP levels (p value of 0.02). No correlation was found with disease activity score (DAS28).Conclusion:US of hands and wrist articulations is more performant than clinical examination in detecting synovitis. The most frequently involved joints with clinical and US synovitis, pain and positive power doppler signal were the wrist joints. CRP level is predictive of the presence of a high simplified power doppler score which is related to clinical activity of the disease as reported by Kawashiri et al. [1].References:[1]Kawashiri S, Kawakami A, Iwamoto N, Fujikawa K, Satoh K, Tamai M, et al. The power Doppler ultrasonography score from 24 synovial sites or 6 simplified synovial sites, including the metacarpophalangeal joints, reflects the clinical disease activity and level of serum biomarkers in patients with rheumatoid arthritis. Rheumatology (Oxford). mai 2011;50(5):962-5.Disclosure of Interests:None declared

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