US DAS better anticipated future joint damage than standard DAS-28.
Objectives To evaluate bone erosions of MTP5 joints in early rheumatoid arthritis (RA) patients (pts) without structural radiographic changes by echosonography and to investigate clinical importance of autoantibodies against citrullinated peptides/proteins (ACPA) and rheumatoid factor (RF) in its detection. Methods A group of 120 patients (85 female) with early RA (≤1 year duration, mean duration 5.4 month, (Eular 2010 classification criteria) were enrolled in the cross sectional study. None of the patients had erosions on radiographs of hands and feet and were not previously treated with DMARDs and/or glucocorticoid. Ultrasound (US) examination of MTP5 joints was performed by Esaote My Lab 70 machine equipped with 8-18 MHz linear probe. Finding of bone erosion was defined according to OMERACT US group definition. The following laboratory parameters in sera of pts were monitored: presence and concentration of ACPA, presence of RF, erythrocyte sedimentation rate (ESR) and level of CRP. Collected data were analyzed in SPSS 16 system. Results A 240 MTP5 joints out of 120 pts were assesed by US.The MTP5 bone erosion was found at 74 (61.7%) pts. Among 120 pts 88 pts were ACPA positive with 257.1 IU/ml mean concentration and 83 pts were RF positive. There was no statistically significant difference between group of pts with and without US detected bone erosions regarding age of pts (56.9 yr. vs 52.5 yr, p=0.333), duration of RA (5.8 vs 4.8 months, p=0.712) and ESR (60.2 vs 50.5, p=0.825). Patients with MTP 5 US detected bone erosion had statistically significant higher concentration of ACPA than pts without US detected bone erosions, (323.8 vs 151.3, p=0.005) and higher level of CRP (39.7 g/l vs 25.3 g/l, p=0.024). Sixty-one ACPA positive pts and 13 ACPA negative had US detected MTP5 bone erosions in opposite to 27 ACPA positive and 19 ACPA negative pts without them. The difference was statistically significant (p=0.01). Fifty-five pts with MTP5 US detected bone erosion had positive RF and 19 pts had RF negative in contrast to 28 RF positive and 18 RF negative pts without them. The difference was not statistically significant (p=0.155). The 0.66 value of the area under the ROC curve was found for ACPA and 0.57 value for RF. The 66% sensitivity and 61% specificity of ACPA and 74% sensitivity and 29% specificity of RF was established in detection of US MTP5 bone erosion for value on 174 of cut off. Conclusions Erosions of MTP 5 joints were detected by echosonography in 62% of early rheumatoid arthritis patients without erosions visible on X-ray. ACPA positivity was weakly associated with presence of MTP5 erosions. There was no significant correlation between US bone erosions and RF positivity. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4252
Background Gray scale ultrasound (US) detects from 2 up to 9 times more erosions on B mode scans than standard radiographs of hand and feet in patients with rheumatoid arthritis (RA). Nowadays, mainly for research purposes, US erosions of small joints were semiquantitatively scored 0–3 according to the Szkudlarek and Scoring by UltraSound Structural erosion (ScUSSe) systems, respectively. Objectives To assess the construct validity of new US erosion score (USES) and ability of new method to detect erosions of small joints in patients with RA as well as to suggest a new USES for erosion quantification. Methods Sixty-three patients (48 females and 15 males) with clinically active disease were prospectively recruited at the Institute of Rheumatology, Belgrade, Serbia. All of them were treated with Methotrexate, or with other DMARDs, including biologic agents. The study was conducted in agreement with the Declaration of Helsinki and was approved by relevant ethics committee. The mean age of patients (S.D.) was 54.7 (12.7) years (range 24-78 years) and the mean disease duration was 28.8 (29.0) months (range 4-156 months). Forty-six pts (73.0%) were rheumatoid factor positive, and 45 pts (71.4%) anti-CCP positive. The patients underwent clinical and laboratory assessment, along with blinded power Doppler US (PDUS) and grey-scale (GS) US (GSUS) examination. A GSUS examination for presence, total surface, and total volume of erosions on 22 joints (2 wrists, 10 metacarpophlangeal joints – MCPs, and 10 metatarsophalangeal joints – MTPs) was performed by two independent examiners, blinded to clinical findings. GSUS examinations were based on standard EULAR reference scans, using US workstation Esaote My Lab 70xvg with 18 MHz linear probe. Surface USES (sUSES) was calculated as a sum of multiplications of long axis with short axis diameters of erosions, and volumetric USES (vUSES) as a sum of multiplications of long axis diameter, short axis diameter, and depth diameter of erosions. Results Five thousand five hundred and forty-four joint quadrants and 1386 joints were examined by two ultrasound operators. Erosions were detected by US in 264 (19,0%) joints. Strong positive linear correlation was found between s USES, vUSES and standard radiographic damage index, such as Sharp van der Heijde score (r=0.66, and r=0.67, respectively, p<0.001). Correlations between sUSES and vUSES with DAS28, HAQ, levels of ESR and CRP were weak and statistically insignificant, except between sUSES with serum levels of CRP (r=0.30, p<0.02). Conclusions Owing to our findings of strong positive linear correlation with the most utilized radiographic score (Sharp van der Heijde score), surface and volumetric ultrasound erosion scores showed at least decent ability to measure damage of hand and feet joints in patients with rheumatoid arthritis. Our next step in development of ultrasound erosion scores will be assessment of reliability and sensitivity to change of these scores in patients with early rheumatoid arthritis. Disclosure of Intere...
ObjectivesTo investigate the association of high baseline MMP-3 serum levels with hands and feet joints structural damage progression, estimated by ultrasonography (US), in patients with early, treatment “naïve” RA without X-ray visible erosions.MethodsSixty-three pts. (9 males and 54 females; mean age 53.4 yrs 21–81±14.1) with early RA (EULAR/ACR 2010 criteria) and symptom duration of ≤12 months (mean duration of 3.8 months) had baseline serum MMP-3 levels tested. Patients had been DMARDs/glucocorticoid naïve, without visible X-ray erosions at the study entry. The subsequent structural joints damages, that were estimated by high frequency linear probe by ESAOTE My Lab 70 machine, as well as clinical markers of disease activity, in the first 2 years were followed. The presence of bone erosion was analyzed at the wrist, MCP2 and MCP5 joints of both hands, as well as at MTP5 joints according to OMERACT US group definition. In order to estimate progression of preexisting erosion the total volume (TV) of bone erosion were calculated by multiplying three diameters (mm): a-the length of erosion; diameter b- the width and diameter c-the depth of erosion. Anova statistical method was performed in data processing.Results46 pts. had basal serum MMP-3 level higher than normal (MMP-3 positive). The 504 joints were assessed summary by US on each visit. The 122 bone erosions in total (1.9 per patient) were depicted at baseline and 213 bone erosions (4.3 per patient) at follow-up visit in whole group. After 24 months MMP3 positive pts. had significantly higher total number of US erosions than MMP-3 negative (3.8 vs. 2.4, p=0.039). The total volume of bone erosion (mm3) was higher in MMP-3 positive than MMP-3 negative pts. after 24 months of treatment, but without statistical significance (18.6 vs. 8.9, p=0.07). MMP-3 positive pts. had a significantly higher value of ESR, CRP and DAS28 than MMP-3 negative pts. at the baseline visit (53.6 vs.25.9, p=0.002; 36.6 vs. 9.5, p=0.005; 6.0 vs. 4.8, p=0.002, respectively). All of those parameters were significantly decreased after 24 months in a group of MMP-3 positive compared to MMP-3 negative pts. (p=0.009, p=0.021, p=0.028, respectively).ConclusionsAfter 2-year of follow-up, US assessment showed a significantly higher number of new bone erosions in patients with early, treatment “naïve” RA and baseline MMP3 levels higher than normal (MMP3 positive) compared to patients with normal baseline levels of MMP3, as well as a biger TV of bone erosions but not statistically significant. The parameters of RA activity (ESR, CRP, DAS28) significantly correlated with baseline MMP-3 levels of higher than normal.Disclosure of InterestNone declared
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