Suprapatellar effusion, Baker's cyst, and higher BMI are more frequent and seem to be risk factors of painful flare in OA of the knee.

Background:In recent years, diverse compounds for intra-articular administration were brought into the market with a subsequent significant and heterogeneous literature production. Understanding the efficacy of intra-articular therapies (IAT) on pain implies bearing in mind the related placebo (PBO) effect. To date, most studies analyzing it were focused on the compound being administered rather than the route of administration.Objectives:We aimed at evaluating the size of the PBO effect after intra-articular injections.Methods:We conducted an overview of systematic reviews (SRs) including randomized-controlled trials (RCTs) of frequently used IAT. SRs with a saline solution PBO arm and high-confidence results according to the AMSTAR-2 tool were selected for analysis.Data on the change in pain in the PBO arms from baseline to 3-6 and 12-16 weeks after the IA procedure was extracted. The standardized mean differences (SMD) from baseline were calculated as the ratio between the size of the intervention effect in each study and the variability observed in that study. A meta-analysis was then performed using an inverse-variance random-effects model in Review Manager 5.3. The overall effect sizes obtained refer to versions of the SMD, which corresponds to the Hedges’ (adjusted) g. e.g. a “g” of 1 indicates the two groups being compared differ by 1 standard deviation and so on.Results:Two SR were included comprising 50 RCTs, 44 not meeting inclusion criteria were excluded so pain, measured by visual analogue scale (VAS) and Lequesne index, was retrieved from 6 RCT.At 3-6 weeks, an SMD [95%CI] = 0.74 [0.47-1.00] was found. One study showing too large an effect was excluded after conducting sensitivity analysis resulting in a significant reduction of heterogeneity with an SMD = 0.62 [0.45-0.79] (Fig.1). At 12-16 weeks, we found a SMD = 0.33 [0.13-0.52] (Fig.2)Figure 1.Forest plot for intra-articular PBO effect at 3-6 weeks after injection.Figure 2.Forest plot for intra-articular PBO effect at 12-16 weeks after injection.Using the interpretation suggested by Cohen1, our results would confirm a moderate to large effect of IA saline (PBO) at 3-6 weeks with a subsequent reduction to a small but persistent effect at 12-16 weeks.Conclusion:Our results showed a moderate to large short-term effect of intra-articular PBO that persisted on the mid-term although reduced. Based on these findings we suggest this effect should be considered when assessing the efficacy of IAT in RCTs and also in clinical practice where it could be maximized as well.References:[1]Cohen J. Statistical Power Analysis in the Behavioural Sciences (2nd edition). Hillsdale (NJ): Lawrence Erlbaum Associates, Inc., 1988.Disclosure of Interests: :Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp & Dohme España, S.A., Sanofi Aventis, UCB Pharma, Raul Castellanos-Moreira Speakers bureau: Lilly, MSD, Sanofi, UCB, Jacqueline Uson Jaeger: None declared, Esperanza Naredo: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

La ecografía es una técnica de amplia implantación en reumatología que implica una gran interacción entre paciente y profesional. La pandemia COVID-19 hace necesario un cambio en nuestra práctica clínica, mediante estrategias que permitan la asistencia integral de nuestros pacientes, garantizando la seguridad tanto de los pacientes como de los profesionales sanitarios. Objetivo: desarrollar unas recomendaciones prácticas, consensuadas entre un panel de expertos, sobre el uso y seguridad de la ecografía reumatológica durante la pandemia COVID-19. Métodos: Analizando la literatura disponible se realizaron unas recomendaciones preliminares, posteriormente consensuadas con un panel de expertos mediante el método Delphi con una escala Likert 1-5. Resultados: Se elaboraron y consensuaron por el panel 5 principios fundamentales y 28 recomendaciones. El consenso del grupo se logró en el 100% de ítems (acuerdo para cada recomendación ≥4 en escala de Likert del 75% de componentes del panel). Conclusiones: El documento proporciona información de utilidad acerca de medidas preventivas en la práctica de ecografía en Reumatología en tiempos de pandemia COVID-19 de acuerdo a la experiencia y literatura disponible hasta el momento.

BackgroundClinical remission is the treatment target for patients with rheumatoid arthritis (RA). However, different definitions have been proposed. Still, damage and/or subclinical inflammation (eg, positive Doppler signal) may persist despite apparent clinical remissionObjectivesTo examine the validity of different definitions of remission and Doppler ultrasound using X-Ray progression as the gold standardMethodsData were obtained from an observational, prospective, multicenter study in RA patients with moderate disease activity (3.2≤DAS28(CRP)≤5.1) who started anti-TNF therapy, conducted under conditions of daily practice. At recruitment and at months 6 and 12, patients were scheduled for a clinical examination, laboratory data collection and reduced 12-joints Power Doppler (PD) ultrasound examination of the wrist, 2nd and 3rd MCP, elbow, knee, and ankle bilateral joints. Synovitis grey scale and PD counts were obtained, and each joint was semi-quantitatively assessed (0 – 3) to obtain grey scale synovitis and PD scores. DAS28 (ESR/CRP), SDAI, CDAI, and ACR/EULAR remission criteria were collected. At baseline and month 12, radiographs of hands and feet were obtained and assessed by an independent observer in pairwise, chronological order and scored according to Sharp-van der Heijde method. X-Ray progression was defined as an increase >1 point and non-progression as ≤0. Patients with doubtful X-ray progression (progression =1), were excluded from independent tests of X-ray progression and US findingsResultsThe sample consisted of 129 patients, 107 women (82.9%), with median (IQR) age of 56.0 (44.0-66.0) years, median time from diagnosis of 5.0 (3.0-11.5) years, and positive rheumatoid factor in 82 patients (63.6%). At 12 months, Sharp-van der Heijde's score median increase was 3.0 (0.0-6.5) points, with 36 patients not progressing and 79 with progression (14 patients with doubtful X-ray progression). Remission rates at 6 and 12 months according to different clinical criteria were: CDAI, 10.5% and 15.9%, SDAI, 12.3% and 15.7%; ACR/EULAR, 12.6% and 14.2%, DAS28ESR, 21.1% and 33.9%; DAS28CRP, 45.9% and 56.7%, respectively. Disease activity at any study time by any composite index (DAS28ESR, DAS28CRP, SDAI, CDAI and ACR/EULAR) was not significantly associated with X-Ray progression. PD score ≥1 at baseline and persistence of PD score ≥1 at 6 months were associated with X-Ray progression: OR=5.067 (IC95%: 1.162 – 21.576; p=0.017), and OR=7.474 (IC95%: 2.644 – 21.123; p<0.0005), respectively.ConclusionsA short 12 joints PD US score shows better predictive validity for structural damage progression in RA than composite indices of disease activity. PD signal, but not clinical disease activity, can predict X-ray progression at 6 and 12 months. Probably in the near future Ultrasound may need to be considered as a component of RA remission criteria.AcknowledgementsThe authors wish to thank Jesus Garrido for providing medical writing and editing services in the development of this abstract and poster. The financial support ...

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