scholarly journals Construct validity and response to therapy of the U9 ultrasonographic scale for assessment of disease activity in rheumatoid arthritis

2021 ◽  
Vol 59 (4) ◽  
pp. 211-218
Author(s):  
Mohamed Mortada ◽  
Hany Aly ◽  
Reem Elmallah ◽  
Ahmed Radwan ◽  
Ahmed Elsaman
Keyword(s):  
Rheumatoid Arthritis ◽  
Construct Validity ◽  
Disease Activity ◽  
Response To Therapy ◽  
Assessment Of Disease Activity

scholarly journals SAT0571 OPTICAL SPECTRAL TRANSMISSION TO ASSESS THERAPY RESPONSE IN PATIENTS WITH ARTHRITIS: A COMPARATIVE STUDY WITH CLINICAL, LABORATORY AND ULTRASONOGRAPHIC ACTIVITY MARKERS.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1244.1-1244
Author(s):  
K. Triantafyllias ◽  
C. Heller ◽  
M. De Blasi ◽  
M. Muthuraman ◽  
A. Schwarting
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Diagnostic Tool ◽  
Clinical Laboratory ◽  
Response To Therapy ◽  
Healthy Controls ◽  
Spectral Transmission ◽  
Time Points ◽  
Before And After ◽  
Assessment Of Disease Activity

Background:Valid assessment of disease activity leads to outcome improvement in patients with rheumatoid arthritis (RA) (1). Optical spectral transmission (OST) is a modern diagnostic tool able to assess the blood-specific absorption of light transmitted through a tissue, promising quantification of inflammation in the finger and wrist joints of RA patients (commercial device: HandScan - Hemics, The Netherlands) (2).Objectives:To our knowledge, there are no data regarding the diagnostic value of OST in the evaluation of inflammatory activity changes during arthitis follow up.Thus, aims of this study were to examine the ability of OST to detect response to anti-inflammatory therapy in patients with arthritis and to explore OST associations with clinical, laboratory and ultrasonographic (US) activity markers.Methods:OST measurements were performed in patients with active arthritides of the wrist and finger joints before and after administration of glucocorticoids (GC), during a disease flare. For the same points in time (a and b) patients and healthy controls underwent clinical, laboratory and joint US [Grey Scale (GSUS) - Power Doppler (PDUS)] examinations. OST-values before and after therapy were subsequently compared with their corresponding DAS28- and US-values. The distributions of Delta-PDUS und OST-values between the two time points were compared by Bayesian statistics. Moreover, OST diagnostic performance was tested by Receiver Operating Characteristics (ROC).Results:We recruited 54 patients with active inflammatory arthritis: 39 RA, 4 gout, 7 peripheral spondylarthritides and 4 other miscellaneous arthritides (66.7% females) and 114 controls.Previous to therapy with GC, median OST was [OST(a):8.75(5.38-16.25, IQR)] and after therapy [OST(b):4.75(2.38-8.63, IQR)] (p<0.05). Similarly, DAS28 dropped significantly after GC therapy [DAS28(a):5.12(4.33-6.10, IQR) vs. DAS28(b):3.85(3.40-4.82),p<0.05)]. OST correlated moderately with PDUS at both time points: (a)rho=0.449and (b)rho=0.414, respectively (both;p<0.01). Moreover, OST correlated significantly with swollen joint count at both time points (a)rho=0.379and (b)rho=0.382,p<0.01respectively.OST and US performed similarly in the assessment of inflammatory changes caused by the administration of GC (same tendency in the change of OST values in83.2%of the cases). Furthermore, Bayesian statistic revealed no significant differences between OST and US for all 3 examined joint categories (MCP:p=0.81; PIP:p=0.74; wrists:p=0.60).In addition, ROC revealed that OST is a very good tool to distinguish patients with arthritis from healthy controls at both examination points [AUC(a):0.883(95% CI=0.83-0.94) and AUC(b):0.811(95% CI=0.74-0.881)].Conclusion:OST was able to assess response to therapy in arthritis patients comparable to US. Moreover, OST correlated with disease activity markers and could effectively differentiate between arthritis patients and controls. Therefore, OST could prove to be a valuable non-interventional time- and resource-saving diagnostic tool to assist arthritis monitoring.References:[1]Katchamart W, et al. Systematic monitoring of disease activity using an outcome measure improves outcomes in rheumatoid arthritis. J Rheumatol 2010;37:1411–1415.[2]Onna M Van, et al. Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique. Ann Rheum Dis 2016;75:511–518.Figure 1.OST-, PDUS- and DAS28- values before and after GC therapy.Figure 2.OST- (group 1) und Ultrasound- (group 2) Bayesian distributions, means- and standard deviation-differences for MCP (A), PIP (B) and wrists (C).Disclosure of Interests:None declared

scholarly journals AB0104 CONCORDANCE BETWEEN THE PHYSICIAN’S AND THE PATIENT’S ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS: RESULTS OF THE AUTODAS-MEAC STUDY AT ONE YEAR

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1080-1080
Author(s):  
N. Ziade ◽  
S. Al Emadi ◽  
M. Abu Jbara ◽  
S. Saad ◽  
L. Kibbi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Middle Eastern ◽  
Weighted Kappa ◽  
Arab Countries ◽  
Das 28 ◽  
The Mean ◽  
One Year ◽  
Middle Eastern Arab ◽  
Assessment Of Disease Activity

Background:Involving the patients with rheumatoid arthritis (RA) in the assessment of their disease may increase their adherence to treatment, improve the disease outcomes and facilitate the application of telehealth. We previously reported an excellent concordance between the Disease Activity Score (DAS-28) performed by physicians and patients at the baseline visit of this prospective study (1).Objectives:To evaluate the persistence of the concordance between the physician’ and the patient’s assessment of disease activity in RA using DAS-28 after one year.Methods:At the baseline visit, patients with RA from 7 Middle Eastern Arab Countries (MEAC) were briefed about DAS-28 by their rheumatologist during a routine consultation and given smartphone access to a video in Arabic language explaining the performance of DAS-28. At 3, 6 and 12 months (± 3 months), the patients were asked to self-report DAS-28, blinded to the physician’s assessment. Concordance between the continuous DAS-28 at each visit was calculated using paired t-test numerically and the Bland-Altman method graphically. Agreement between physician- and patient-DAS categories (remission, low-, moderate- and high disease activity) was calculated at each visit using weighted kappa for category comparison. Weighted kappa of the different agreements were compared over time using their respective confidence intervals (CIs). Predictive factors of positive concordance between physician and patient-DAS were identified using binary logistic regression.Results:The study included 428 patients over a period of three years (2018 to 2020). The mean age of participants was 49.8 years, 82.5% were females, 44.3% had a university degree and the mean disease duration was 11.4 years.At baseline, the average patient-DAS was higher (4.06 (±1.52)) than the physician-DAS (3.97 (±1.52)). The mean difference was -0.09 [95%CI -0.14; -0.04] and most of the pairs were within the limit of agreement in the Bland-Altman graph, indicating a good concordance, particularly in cases of remission.During the study follow-up, 299 patients consulted for visit 2 (69.9% of the total population), 232 for visit 3 (54.2%) and 199 for visit 4 (46.5%). The weighted kappa was 0.80 [95%CI 0.76;0.85] at visit 1 and 0.79 [95%CI 0.72;0.88] at visit 4 (Figure 1 showing kappa for DAS-28, CDAI and SDAI as well). A minor numerical decrease in kappa was observed over time; however, the CIs were overlapping over the four visits and the agreement was considered stable, remaining in the excellent range. At visit 4, a positive concordance between the physician- and the patient-DAS was associated with the profession (lower in blue collar, p=0.001), the educational level (higher in high school and university, p=0.034) and the baseline physician’s DAS (higher in high disease activity, p=0.46).Conclusion:The agreement between the DAS-28 performed by the physician and by the patient was excellent at baseline and remained stable over one year. A positive concordance was associated with the profession, the educational level and the level of disease activity. The present study can help the rheumatologist make informed decisions about the patients who may be suitable for a remote evaluation of their disease activity, that can be of particular interest in the context of the COVID-19 pandemic.References:[1]Ziade N, Saad S, al Mashaleh M, et al. Perceptions of Patients with Rheumatoid Arthritis about Self-Assessment of Disease Activity after Watching an Educational Video: Qualitative Pilot Results from the Auto-DAS in Middle Eastern Arab Countries Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10).Acknowledgements:The authors would like to acknowledge the patients for participating in the study and the assistants/ students/ nurses who assisted in the data collection: Dr. Fatima Abdul Majeed Al Hawaj, M. Atef Ahmed, M. Mohammad Alhusamiah, Ms Raquel De Guzman, Ms Lina Razzouk.Disclosure of Interests:None declared

scholarly journals POS1405 OPTICAL SPECTRAL TRANSMISSION (HANDSCAN) IN PATIENTS WITH PSORIATIC ARTHRITIS: FIRST DATA ON DIAGNOSTIC VALUE AND ASSOCIATIONS WITH CLINICAL AND ULTRASOUND DISEASE ACTIVITY MARKERS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 985.1-985
Author(s):  
K. Triantafyllias ◽  
S. Liverakos ◽  
C. Noack ◽  
A. Schwarting
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Power Doppler ◽  
Patient Characteristics ◽  
Diagnostic Value ◽  
Control Group ◽  
Spectral Transmission ◽  
Grey Scale ◽  
Assessment Of Disease Activity

Background:Valid assessment of disease activity leads to improvement of long-term outcomes in patients with inflammatory arthritis (1). Optical spectral transmission (OST) is a modern diagnostic tool able to assess the blood-specific absorption of light transmitted through a tissue, promising quantification of inflammation in the finger and wrist joints of patients with rheumatoid arthritis (RA) (commercial device: HandScan – Demcon/Hemics, The Netherlands) (2). Even though an increasing number of studies have evaluated diagnostic value of this new technology in RA patients (2,3), no data exist regarding psoriatic arthritis (PsA).Objectives:To examine for the first time the diagnostic value of OST in detecting inflammation in patients with PsA and to evaluate its relationship with disease activity markers and various epidemiological and anthropometric patient characteristics.Methods:OST-Measurements were performed in a group of PsA patients and a group of healthy controls. The difference between OST in the two groups was statistically examined and relationships of OST with clinical (tender / swollen joint counts, disease activity on a visual analogue scale) and serological disease activity markers were evaluated. Moreover, joint ultrasound (US) examinations were performed in a subgroup of PsA patients and OST associations with a Power Doppler- and a Grey Scale-US score were examined. Finally, relationships of OST with various anthropometric and epidemiologic parameters (BMI, hand-size, gender, age) were assessed.Results:We recruited 49 PsA patients [65.3% female; mean age 53.3 years (± 11.8 SD)] and 114 control subjects [77.2% female; mean age 46 years (± 12.8 SD)]. OST was statistically significantly higher in the patient group, compared to the control group [14.95 (12.04 - 17.18, IQR) vs. 10.31 (7.84 – 13.79, IQR); p<0.001]. OST correlated moderately-strongly with both examined US scores (Power Doppler-score: r = 0.5; p = 0.026 and Grey Scale-score: r = 0.52; p = 0.028). Moreover, OST showed a moderate, statistically significant association with C-reactive protein (CRP) (r = 0,298; p = 0,037). Finally, males had significantly higher OST values than females and OST associated moderately-weakly with body mass index (BMI) in the control group (rho = 0.24; p< 0.001).Conclusion:This is the first report of a possible diagnostic value of OST in patients with PsA. OST correlated with ultrasound and serological activity markers and may thus prove to be a useful tool of disease activity assessment, next to well established diagnostic modalities, such as the joint US. Correlations of OST with patient characteristics implicate the need to take also anthropometric and epidemiological patient characteristics into account when interprenting OST results in order to avoid confounding.References:[1]Katchamart W, et al. Systematic monitoring of disease activity using an outcome measure improves outcomes in rheumatoid arthritis. J Rheumatol 2010;37:1411–1415.[2]Triantafyllias, et al. Diagnostic value of optical spectral transmission in rheumatoid arthritis: associations with clinical characteristics and comparison with joint ultrasonography. J Rheumatol 2020 1;47(9):1314-1322.[3]Onna M Van, et al. Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique. Ann Rheum Dis 2016;75:511–518.Disclosure of Interests:Konstantinos Triantafyllias Speakers bureau: Pfizer, Novartis, Janssen, Chugai, Stefanie Liverakos: None declared, Claudia Noack: None declared, Andreas Schwarting: None declared

Fluorodeoxyglucose positron emission tomography/computed tomography in the diagnosis, assessment of disease activity and therapeutic response in relapsing polychondritis

Rheumatology ◽  
2019 ◽  
Vol 59 (1) ◽  
pp. 99-106 ◽  
Author(s):  
Aman Sharma ◽  
Rajender Kumar ◽  
Adarsh MB ◽  
G S R S N K Naidu ◽  
Vikas Sharma ◽  
...  
Keyword(s):  
Disease Activity ◽  
Fdg Pet ◽  
Therapeutic Response ◽  
Clinical Symptoms ◽  
Relapsing Polychondritis ◽  
Response To Therapy ◽  
Ct Examination ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Assessment Of Disease Activity

Abstract Objective To evaluate 18F-fluorodeoxyglucose (FDG) PET/CT in the assessment of disease activity, extent of the disease and response to therapy in relapsing polychondritis. Methods Twenty-five patients (9 men, 16 women) with a mean age of 38.2 years (s.d. 13.7; range 18–62), diagnosed to have relapsing polychondritis according to Damiani and Levine’s modification of McAdam’s criteria, who underwent PET/CT examination were included. Ten patients underwent a second PET/CT examination after therapy or during follow-up. Clinical symptoms and auxiliary examination findings were recorded. PET/CT findings were reviewed and correlated with the clinical symptoms. Results The major symptoms were aural pain (n = 21), nasal pain (n = 10), stridor (n = 5), cough (n = 9), fever (n = 8) and laryngeal tenderness (n = 8). The initial PET/CT was positive in 23/25 patients. PET/CT revealed involvement of auricular (n = 14), nasal (n = 8), laryngeal (n = 7), tracheobronchial (n = 6) and Eustachian (n = 3) cartilages with a mean maximum standardized uptake value (SUVmax) of 4.1 (s.d. 2.5; range 1.7–12.7). Fair correlation of aural/nasal pain/stridor with FDG avidity of cartilage involvement on PET/CT was noted. The key finding was detection of asymptomatic large airway involvement in seven patients (28%). Re-examination PET in 10 patients revealed complete therapeutic response (n = 5), partial response (n = 1), stable disease (n = 1), progressive disease (n = 1) and disease recurrence (n = 2). Conclusion FDG PET/CT is a useful tool for the assessment of the disease activity and extent. It identified activity in clinically inaccessible sites that are of clinical significance. It is also useful in assessing treatment response and finding relapse.

scholarly journals Effect of disease duration and prior disease-modifying antirheumatic drug use on treatment outcomes in patients with rheumatoid arthritis

2019 ◽  
Vol 78 (12) ◽  
pp. 1609-1615 ◽  
Author(s):  
Daniel Aletaha ◽  
Jen-fue Maa ◽  
Su Chen ◽  
Sung-Hwan Park ◽  
Dave Nicholls ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Disease Duration ◽  
Activity Index ◽  
Health Assessment ◽  
Disease Activity Index ◽  
Response To Therapy ◽  
Joint Disease ◽  
Adalimumab Therapy ◽  
Disease Modifying

ObjectivesTo determine if disease duration and number of prior disease-modifying antirheumatic drugs (DMARDs) affect response to therapy in patients with established rheumatoid arthritis (RA).MethodsAssociations between disease duration or number of prior DMARDs and response to therapy were assessed using data from two randomised controlled trials in patients with established RA (mean duration, 11 years) receiving adalimumab+methotrexate. Response to therapy was assessed at week 24 using disease activity outcomes, including 28-joint Disease Activity Score based on C-reactive protein (DAS28(CRP)), Simplified Disease Activity Index (SDAI) and Health Assessment Questionnaire Disability Index (HAQ-DI), and proportions of patients with 20%/50%/70% improvement in American College of Rheumatology (ACR) responses.ResultsIn the larger study (N=207), a greater number of prior DMARDs (>2 vs 0–1) was associated with smaller improvements in DAS28(CRP) (–1.8 vs –2.2), SDAI (–22.1 vs –26.9) and HAQ-DI (–0.43 vs –0.64) from baseline to week 24. RA duration of >10 years versus <1 year was associated with higher HAQ-DI scores (1.1 vs 0.7) at week 24, but results on DAS28(CRP) and SDAI were mixed. A greater number of prior DMARDs and longer RA duration were associated with lower ACR response rates at week 24. Data from the second trial (N=67) generally confirmed these findings.ConclusionsNumber of prior DMARDs and disease duration affect responses to therapy in patients with established RA. Furthermore, number of prior DMARDs, regardless of disease duration, has a limiting effect on the potential response to adalimumab therapy.

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