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

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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AB1066 The Pattern of Power Doppler Signal at the Joint Level in Patients with Rheumatoid Arthritis: Its Association with Disease Activity:

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-eular.2425 ◽

2015 ◽

Vol 74 (Suppl 2) ◽

pp. 1256.2-1257

Author(s):

M.J. Audisio ◽

G.E. Py ◽

A.M. Bertoli

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Power Doppler ◽

Doppler Signal ◽

Joint Level ◽

Power Doppler Signal

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POS0548 OPTIMAL ASSESSMENT OF THE RHEUMATOID ARTHRITIS ANKLE AND HINDFOOT: A COMPARATIVE STUDY BETWEEN CLINICAL EXAMINATION AND ULTRASONOGRAPHY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2720 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 508.2-509

Author(s):

K. Maatallah ◽

H. Boussaa ◽

H. Riahi ◽

H. Ferjani ◽

M. Habechi ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Examination ◽

Demographic Data ◽

Power Doppler ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Therapeutic Decisions ◽

The Mean ◽

Foot Disease

Background:Foot disease is a common problem in rheumatoid arthritis (RA). Therapeutic decisions are often based on clinical examination (CE) alone, which can be adversely affected by factors such as deformity, obesity, and peripheral edema. Ultrasonography (US) has previously been shown to be more sensitive than CE for detecting synovitis and tenosynovitis in RA forefeet, but few data exist for the hindfoot and ankle.Objectives:The aim of this study was to compare CE and US for the detection of hindfoot and ankle synovitis and tenosynovitis in patients with established RA.Methods:We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data and disease parameters were collected. CE was performed by a rheumatologist for the presence or absence of tenderness, swelling, and mobility restriction of both ankles. The following tendons were examined for tenosynovitis: tibialis anterior (TA) and posterior (TP), fibularis longus (FL), and brevis (FB) (assessed together). In a second time, US examination of the tibiotalar, talonavicular, and subtalar joints and the same tendons as CE was performed by a blinded radiologist experienced in musculoskeletal imaging using a Philips HD11 device with a high-frequency linear transducer. The presence or absence of synovitis and tenosynovitis was recorded, and the composite synovitis score (power doppler / grayscale ultrasound (PDUS)) was measured for each joint. The US score of each patient was defined by the sum of the composite scores of the joints studied (0-30). A p-value <0.05 was considered significant.Results:Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].Clinical examination of ankles revealed tenderness in 57.4% of cases, swelling in 38.8% of cases, and restriction in the range of motion in 11.1% of cases. TA tenosynovitis was noted in 14.8% of cases, TP tenosynovitis in 22.2% of cases, and FL and FB tenosynovitis in 31.5% of cases.US showed tibiotalar synovitis in 59.3% of cases, talonavicular synovitis in 64.8% of cases, and subtalar synovitis in 46.3% of cases. TA tenosynovitis was noted in 5.6% of cases, TP tenosynovitis in 22.2% of cases, and FB and FL tenosynovitis in 25% and 11.1% of cases respectively.An association was found between clinical tenderness and US synovitis of the tibiotalar joint (p=0.013) and the talonavicular joint (p=0.027). No association was noted between clinical swelling and US synovitis in these joints.No association was noted between clinical and US tenosynovitis of TA (p=0.279), TP (p=0.436), FB (p=0.495) and FL (p=0.315).Conclusion:Clinical examination of RA ankles may be challenging and needs to be coupled with US, which is more sensitive and accurate in the detection of synovitis and tenosynovitis.Disclosure of Interests:None declared

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AB0179 INFLUENCE OF AINFLUENCE OF ANTI-CITRULLINATED PROTEIN/PEPTIDE ANTIBODIES (ACPAS)ON ARTICULAR MANIFESTATIONS, DISEASE ACTIVITY AND STRUCTURAL SEVERITY IN ALGERIAN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3657 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1115.1-1115

Author(s):

F. Rahal ◽

N. Brahumi ◽

A. Ladjouze-Rezig ◽

S. Lefkir

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Early Rheumatoid Arthritis ◽

Disease Activity Score ◽

Activity Score ◽

Symptom Duration ◽

Early Ra ◽

The Mean ◽

Citrullinated Protein ◽

Peptide Antibodies

Background:Anti-citrullinated protein/peptide antibodies (ACPA) are highly specific and sensitive markers for rheumatoid arthritis (RA). There are also suggested to have a more severe rheumatoid arthritis.Objectives:The aim of this study was to assess the influence of ACPA on disease activity, radiological severity, and functional disability in Algerian patient with early rheumatoid arthritis (RA).Methods:Consecutive early RA patients (symptom duration ≤24 months) recruited were included in the descriptive, longitudinal, prospective study. Demographic, biological, immunological and radiographic data were collected at the time of inclusion in the study. Disease activity as determined by the Disease Activity Score 28-CPR (DAS28- CPR: 4 variables), functional handicap as calculated by Heath Assessment Score (HAQ), and bone and joint damage as evaluated by Sharp-Van der Heijde (SVDH) erosion and narrowing score.Results:One hundred and sixty-one patients with RA were recruited. Patients mean age 43.71±14 years and mean symptom duration at inclusion was 10.48±7 months. Small and larges were affected in 64,3%. The mean ESR was 23,53±15,2 mm/1st hour, and the mean CRP level was 19,42±39.8 mg/l. Rheumatoid Factors (RFs) and Anti-Citrullinated Protein Antibodies (ACPAs) were present in 74% and 88% of patients, respectively. The presence of ACPAs was significantly associated with DAS28 (p=0,004) and HAQ (p=0,002). There was no significant difference in inflammatory markers and radiographic SVDH score between patients with and without ACPAs. Stepwise regression analysis showed that the presence of ACPAs was independently associated with localization when RA affected smalls and larges joint in the same time (OR=5,24; IC 95% 1,224-22,483; p=0,026).Conclusion:These data show that in patients with early RA, ACPAs positivity was significantly associated with articular manifestations, activity disease and functional handicap, but not with structural damage.References:[1]Nikiphorou E, Norton S, Young A, et al. Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds. Ann Rheum Dis. 2016;75(12):2080-2086. doi:10.1136/annrheumdis-2015-208669.[2]Karimifar M, Salesi M, Farajzadegan Z. The association of anti-CCP1 antibodies with disease activity score 28 (DAS-28) in rheumatoid arthritis. Adv Biomed Res. 2012;1:30. doi:10.4103/2277-9175.98156.[3]Boman A, Brink M, Lundquist A, et al. Antibodies against citrullinated peptides are associated with clinical and radiological outcomes in patients with early rheumatoid arthritis: a prospective longitudinal inception cohort study. RMD Open. 2019;5(2):e000946. Published 2019 Sep 3. doi:10.1136/rmdopen-2019-000946.Disclosure of Interests:None declared

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Clinical and ultrasound remission after 6 months of treat-to-target therapy in early rheumatoid arthritis: associations to future good radiographic and physical outcomes

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-212830 ◽

2018 ◽

Vol 77 (10) ◽

pp. 1421-1425 ◽

Cited By ~ 8

Author(s):

Nina Paulshus Sundlisæter ◽

Anna-Birgitte Aga ◽

Inge Christoffer Olsen ◽

Hilde Berner Hammer ◽

Till Uhlig ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Disease Activity Score ◽

Radiographic Progression ◽

Activity Index ◽

Power Doppler ◽

Disease Activity Index ◽

Treat To Target ◽

Good Outcome ◽

Grey Scale

ObjectiveTo explore associations between remission, based on clinical and ultrasound definitions, and future good radiographic and physical outcome in early rheumatoid arthritis (RA).MethodsNewly diagnosed patients with RA followed a treat-to-target strategy incorporating ultrasound information in the Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen (ARCTIC) trial. We defined 6-month remission according to Disease Activity Score, Disease Activity Score in 28 joints-erythrocyte sedimentation rate, American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean criteria, Simplified Disease Activity Index, Clinical Disease Activity Index and two ultrasound definitions (no power Doppler signal, grey scale score ≤2). Two outcomes were defined: no radiographic progression and good outcome (no radiographic progression+physical function≥general population median), both sustained 12–24 months. We calculated the ORs of these outcomes for the remission definitions.ResultsOf 103 patients, 42%–82% reached remission at 6 months, dependent on definition. Seventy-one per cent of patients had no radiographic progression and 37% had good outcome. An association between 6-month remission and no radiographic progression was observed for ACR/EULAR Boolean remission (44 joints, OR 3.2, 95% CI 1.2 to 8.4), ultrasound power Doppler (OR 3.6, 95% CI 1.3 to 10.0) and grey scale remission (OR 3.2, 95% CI 1.2 to 8.0). All clinical, but not ultrasound remission criteria were associated with achievement of a good outcome.ConclusionsOur data support ACR/EULAR Boolean remission based on 44 joints as the preferred treatment target in early RA. Absence of ultrasound inflammation was associated with no radiographic progression.Trial registration numberNCT01205854; Post-results.

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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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Synovial Tissue Sublining CD68 Expression Is a Biomarker of Therapeutic Response in Rheumatoid Arthritis Clinical Trials: Consistency Across Centers

The Journal of Rheumatology ◽

10.3899/jrheum.090348 ◽

2009 ◽

Vol 36 (8) ◽

pp. 1800-1802 ◽

Cited By ~ 65

Author(s):

BARRY BRESNIHAN ◽

ELIZA PONTIFEX ◽

ROGIER M. THURLINGS ◽

MARJOLEIN VINKENOOG ◽

HANI EL-GABALAWY ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Disease Activity Score ◽

Early Stage ◽

Medical Center ◽

Biological Effects ◽

Pearson Correlation ◽

University Hospital ◽

Mean Values ◽

The Mean

Objective.To determine whether the correlation between the mean change in disease activity and the mean change in synovial sublining (sl) CD68 expression could be demonstrated across different academic centers.Methods.Synovial biopsies obtained at arthroscopy from patients with rheumatoid arthritis before and 160 days after rituximab therapy were selected and coded. Paired sections were processed independently at Amsterdam Medical Center (AMC) and at St. Vincent’s University Hospital (SVUH), Dublin. Digital image analysis (DIA) was employed at both centers to quantify sublining CD68 expression.Results.After analysis of CD68sl expression at centers in 2 different countries, high levels of intracenter and intercenter agreement were observed. For the pooled sections stained at AMC, the correlation between 2 investigators was R = 0.942, p = 0.000, and for sections stained at SVUH, R = 0.899, p = 0.001. Similarly, the intracenter correlations for ΔCD68sl expression after treatment were R = 0.998, p = 0.000, for sections stained at AMC and R = 0.880, p = 0.000, for sections stained at SVUH. The intercenter correlation for the pooled scores of sections stained at AMC was R = 0.85, p = 0.000, and for the sections stained at SVUH, R = 0.62, p = 0.001. The consistent correlation between ΔDAS (Disease Activity Score) and ΔCD68sl expression across different studies (Pearson correlation = 0.895, p < 0.001) was confirmed. The standardized response mean values for ΔCD68sl, calculated from analyses at both AMC and SVUH, were consistently 0.5 or greater, indicating a moderate to high potential to detect change.Conclusion.The correlation between mean ΔDAS and mean ΔCD68sl expression was confirmed across 2 centers. Examination of serial biopsy samples can be used reliably to screen for interesting biological effects at the site of inflammation at an early stage of drug development.

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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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Demodex folliculorum in patients with rheumatoid arthritis

Acta Parasitologica ◽

10.2478/s11686-007-0002-7 ◽

2007 ◽

Vol 52 (1) ◽

Cited By ~ 2

Author(s):

Ihsan Ciftci ◽

Umit Dundar ◽

Zafer Cetinkaya ◽

Mustafa Kulac ◽

Nilay Kiyildi ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Disease Activity Score ◽

Disease Duration ◽

Demodex Folliculorum ◽

Das 28 ◽

Immunosuppressed Patients ◽

The Mean ◽

Demodex Mites ◽

Assessment Of Disease Activity

AbstractThe objective of this study was to investigate the incidence and density of Demodex folliculorum in the patients with rheumatoid arthritis (RA). Forty-one patients with RA and twenty-seven age and sex matched healthy controls were enrolled in this study. Disease Activity Score (DAS 28) was used for the assessment of disease activity. Out of 41 patients, 33 were females and 8 males. The mean disease duration was 10.9 ± 8.2 years. The mean DAS 28 was 3.8 ± 1.2. No statistically significant differences in the incidence and density of Demodex mites were found between patients with RA and controls. Although immunosuppression is thought to be a risk factor for the D. folliculorum infestation no such correlations could be found in the 41 immunosuppressed patients with RA, therefore, further studies with larger groups are needed.

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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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