Which US or MRI Characteristics Are Associated With Radiographic Progression In Ra Patients In Low Disease Activity? An Observational Prospective Study

V. Foltz1, F. Gandjbakhch1, F. Etchepare1, C. Rosenberg2, A. Monnier3, C. Poulain1, S. Rozenberg1, M.L. Tanguy4, P. Bourgeois1, B. Fautrel1 1Rheumatology, CHU Pitié Salpêtrière, paris; 2Rheumatology, Hopital, Argenteuil; 3Rheumatology, Hopital, Pau; 4Departement de Statistiques, CHU Pitié Salpêtrière, Paris, France

Background: Therapeutic objective in rheumatoid arthritis (RA) is low disease activity (LDA). However some studies have shown that structural damage progression remains possible in up to 10-20% of such patients.

Objectives: To identify which US and MRI findings are predictive of radiological structural progression at one year in RA patients in LDA.

Methods: Patients were included between Feb. 2007 and Feb. 2008 and prospectively followed during 1 year. Inclusion criteria were: RA based on the 1987 ACR criteria, disease onset in 2000 or after-, stable DAS44 ≤ 2.4 at inclusion (i.e., LDA or remission). All patients underwent clinical and biological assessments every three months. At baseline, all patients underwent high resolution US of the hands and forefeet (ESAOTE technos) and low-field dedicated MRI of the dominant hand (ESAOTE C-scan 0.2T). MRI and US were performed and evaluated blindly using validated acquisition and OMERACT scoring system. Hands and forefeet X-ray were performed at baseline and at 12 months and evaluated blindly by two investigators with the van-der–Heijde-modified Sharp score (SHS). Progression was defined as a variation of the SHS erosion superior to 1. The determinants of structural progression were analyzed by stepwise logistic regression.

Results: 85 patients were included (38 in LDA and 47 in Remission), 15 being treated with biologics; 80 (94%) completed the study. Characteristics were as follow: mean age 50.6 years; mean disease duration 2.9 years, mean DAS44 1.5, female 85%, presence of rheumatoid factor and/or anti-CCP antibodies 66%. 9 patients (11.3%) had X-ray progression at 1 year.
In multivariate analysis, the only predictor of structural damage progression was US Doppler grade: OR 1.4 (95%IC: 1.06; 1.86); p=0.005. None of the clinical, biological, therapeutical and MRI characteristics was associated with structural damage progression on X-rays.

Conclusion: PD signal on hand and feet US is the only predictive factor of structural progression in patients in low disease activity or remission. US is complementary to clinical/biological assessment and may contribute to more optimal therapeutic decision making.

Disclosure of Interest: None declared

Citation: Ann Rheum Dis 2010;69(Suppl3):353

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