AB1074 Utility of the Stricter Remission Criteria for Assessing the Absence of Subclinical Activity in Rheumatoid Arthritis

Abstract

BackgroundIt has been seen that patients who achieve remission measured by DAS28 persist with subclinical synovitis on hands and toes evaluated by ultrasound. In recent times stricter criteria as the CDAI, SDAI and ACR EULAR Boolean have been proposed.ObjectivesTo evaluate the stricter criteria as diagnostic test with ultrasound considered as reference test or gold standard in patients in remission for DAS28.MethodsWe evaluated consecutive patients in remission by DAS28 less than 2,6. Strict criteria were applied. A rheumatologist specializing in musculoskeletal ultrasound, who was unaware of the clinical status and laboratory activities, performed ultrasonography on hands and and toes. Systematic evaluation was performed on grayscale and Doppler technique with multifrequency linear transducer (10 -18 MHz) in longitudinal and transverse sections of radiocarpal joint, second and third metacarpophalangeal, second and third proximal interphalangeal in both hands, second to fifth metatarsophalangeal joint, bilateral. It was considered as cases, synovitis absence grade II-III and/or Power Doppler II-III using OMERACT's definitions. We defined controls as the ones with at least one of these signs of activity. We consider positive diagnosis test to remission status for different stricter criteria. Sensitivity, specificity, positive likelihood ratio, positive predictive value (PPV) and negative predictive value (NPV).Results100 scans were performed in 100 patients, 80% were women (n=80) and the mean age 52.7 SD 12. There were no differences in age, sex, duration of disease, treatment, or RF and anti CCP positivity between cases and controls. Of the ultrasound screening 58 didn't have signs of activity and 42 had synovitis and/or PD grade II-III. Table 1 shows the status of activity and Table 2 shows the results.Table 1Ultrasound without activity on hands and toesn (%)Remission by Boolean ACR/EULAR criteria (n=45)16 (36)No Remission by Boolean ACR/EULAR criteria (n=55)26 (47)Remission by SDAI (n=70)29 (41)No remission by SDAI (n=30)13 (43)Remission by CDAI (n=62)26 (41)No remission by CDAI (n=38)16 (42) Table 2SensitivitySpecificityPPVNPVPositive LR% (95 CI)% (95 CI)% (95 CI)% (95 CI)Boolean ACR/EULAR38 (29–48)50 (40–60)36 (26–45)53 (43–63)0,8 (0,5–1,2)CDAI62 (53–71)38 (28–47)42 (32–52)58 (48–68)1 (0,8–1,3)SDAI69 (60–78)29 (20–38)41 (32–51)57 (47–66)1 (0,8–1,3) ConclusionsWe found that in this population, which is in remission for DAS28, none of the three criteria is of great value to detect absence of activity using ultrasound as gold standard.ReferencesFelson DT, Smolen JS, Wells G, Zhang B, van Tuyl LH, Funovits J, et al. American College of Rheumatology; European League Against Rheumatism. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011; 63:573-86.Disclosure of InterestNone declared