Which US or MRI Characteristics Are Associated With Relapse In Ra Patients In Low Disease Activity Or Remission? An Observational Prospective Study

V. Foltz1, F. Gandjbakhch1, F. Etchepare1, A. Monnier1, C. Rosenberg2, C. Poulain3, S. Rozenberg1, M.L. Tanguy4, P. Bourgeois1, B. Fautrel1 1Rheumatology, CHU Pitié Salpêtrière, Paris; 2Rheumatology, Hospital, Argenteuil; 3Rheumatology, CHU Pitié Salpêtrière, Pau; 4Département de statistiques, CHU Pitié Salpêtrière, Paris, France

Background: Remission and low disease activity (LDA) are the consensual therapeutic objective in rheumatoid arthritis (RA). Once this objective achieved, the identification of patients at risk of relapse would help making therapeutic decisions (treatment reduction or maintenance).

Objectives: To identify which US and MRI findings are predictive of relapse within the year in RA patients in LDA or remission.To identify which US and MRI findings are predictive of relapse within the year in RA patients in LDA or remission.

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. Relapse was defined as DAS > 2.4 at one visit during follow up. The determinants of relapse 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 follow-up. Mean characteristics were as follow: age 50.6 years; disease duration 35.3 months, DAS44 1.5, female 85%, positive rheumatoid factor and/or anti-CCP antibodies 66%. 26 (32.5%) patients relapsed during the 1-year follow up. In univariate analysis, determinants associated with relapse were anti-CCP antibodies (p=0.03), US Doppler synovitis and grade (p=0.004 and 0.005, respectively) and MRI synovitis (p=0.03). In the multivariate analysis, the only 2 predictors of RA relapse were US power Doppler synovitis and Duration of RA (table).

Conclusion: Disease duration and power Doppler signal in US are the only parameters to predict relapse. US examination is complementary to clinical/biological assessment in RA patients in LDA or remission and to help optimizing therapeutic choices in such patients.

Disclosure of Interest: None declared

Citation: Ann Rheum Dis 2010;69(Suppl3):308

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