Artikel
Ultrasound predictors of radiographic damage in patients with early rheumatoid arthritis (ACPA‑positive versus ACPA‑negative rheumatoid arthritis)
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Autoren
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Olga Alekseeva
- V.A. Nasonova Research Institute of Rheumatology, Moscow
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Aleksander Smirnov
- V.A. Nasonova Research Institute of Rheumatology, Moscow
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Svetlana Glukhova
- V.A. Nasonova Research Institute of Rheumatology, Moscow
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Alexander Volkov
- V.A. Nasonova Research Institute of Rheumatology, Moscow
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Eugene Nasonov
- V.A. Nasonova Research Institute of Rheumatology, Moscow
| Veröffentlicht: | 9. September 2020 |
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Gliederung
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Introduction: Rheumatoid arthritis (RA) is the most prevalent chronic inflammatory joint disease, and it is responsible for structural damage. Several studies have shown that ACPA + patients were more likely than ACPA− patients to develop erosive changes on radiography. Ultrasound (US) changes in early RA are considered as one of the ways of predicting disease outcomes too.
Objective: to identify the prognostic role of ultrasound signs (US) in radiologic progression in RA patients
Methods: 56 patients with RA, mean age 53,5 [45,5; 61,0], disease duration 5 [3; 7,5] months, were treated with MTX and biologics according to Treat-To-Target concept. Hands and feet ultrasound (US) with gray scale (GS), power Doppler (PD) and destructive changes (erosion), according to the criteria of OMERACT, were analyzed before initiation of treatment and in 3, 6, 9 and 12 months after. A binary scoring system (presence/absence of erosions) of the joints examined was used. Radiographs were obtained at baseline, at 12 months and 4 years, radiographic changes were assessed using Sharp/van der Heijde modified scoring method. Radiographic progression was documented based on Sharp/Van der Heijde modified score changes during the follow up.
Results: 49 ACPA+ (87%) and 7 ACPA− (3%) patients presented among the 56 patients with early RA.
During the follow-up period 17 of 56 patients had radiographic progression: the count of erosion increased from 0 [0; 1] to 4 [2; 7]. At the same time, on the background of therapy, a decrease in ultrasound signs of inflammation was determined according to the GS and PD: from 6 [4; 9] to 1 [0; 3] p = 0.000 and from 2 [1; 5] to 1 [0; 2] p = 0.000, respectively, and increase in the number of joints with erosions (from 1 [0; 2] to 2 [1; 3], p = 0.000).
In ACPA+ group the count of erosion at 4 years was significantly higher than in ACPA− group (2 [0; 4] and 0 [0; 0], respectively, p=0.009). PD at 6 months was significantly higher in ACPA+ group than in ACPA− group (1 [0; 3,5] and 0 [0; 0], respectively, p=0.048).
On multivariate analysis with the construction of the Cox model in the group with early RA, we tested the ability of the US signs to predict radiographic evidence of erosive arthritis at 4 years.
The presence PD-positive synovitis at 6 months of observation was associated with risk of radiographic progression at 4 years (OR 4.32 [1.44-12.93, p = 0.006], the increase in the number of joints with erosion at 6 months of observation increased the risk (OR 3.15 [95% CI 1.08-9.2], p = 0.035). The high ESR at 3 months of observation was associated with risk of radiographic progression at 4 years (OR 1.03 [95% CI 1.0-1.05], p = 0.004). This model demonstrated acceptable significance: R2 = 0.69.
Conclusion: Thus, in early RA is advisable to perform an US of the hands and feet 6 months after the start of therapy to select a group of patients with potentially rapid radiological progression.
Disclosures: None declared
