SAT0607 Grey Scale or Doppler Ultrasound, Joint Counts or Summative Scores. Which One is a Better Predictor of X-Ray Progression?

Abstract

BackgroundThere is growing evidence in rheumatoid arthritis (RA) that ultrasound assessments (UA) have a better predictive value for X-ray progression than clinical assessmentsObjectivesTo analyze the association between UA with a reduced 12-joint ultrasound (US) power Doppler (PD) examination and X-ray progression at 12 monthsMethodsPatients were included with available X-ray examination in a multicenter, observational, prospective cohort of RA patients with moderate disease activity (3.2≤DAS28≤5.1), conducted under conditions of routine daily practice (ECO-DAIStudy) 12-joint PDUS assessments were performed at baseline, 6 and 12 months. Synovitis grey scale (SGS) and PD counts were obtained, and each joint was semi-quantitatively assessed (0 – 3) to obtain SGS and PD scores. X-ray examinations were performed at baseline and at 12 months. An independent, blinded observer read paired films in chronological order and scored them according to Sharp-van der Heijde method. X-ray progression was defined as an increase >1 point and non-progression as ≤0. In order to increase contrast, patients with doubtful X-ray progression (>0 - ≤1) were excluded from association analyses of X-ray progression and US findings. Several cutoffs for SGS and PD were tested, and sensitivity (Se) and specificity (Sp) were computed when a significant association was foundResultsThe sample consisted of 129 patients, including 107 women (82.9%), with median (IQR) age of 56.0 (44.0-66.0) yrs, median time from diagnosis of 5.0 (3.0-11.5) yrs, and rheumatoid factor positivity in 82 patients (63.6%). At baseline, 6 and 12 months, the median (IQR) values of SGS counts were 5.0 (4.0-8.0), 5.0 (2.0-7.0) and 4.0 (2.0-6.0); SGS scores were 8.0 (5.0-11.0), 5.0 (3.0-8.0) and 5.0 (2.0-7.8); PD counts were 4.0 (2.0-6.0), 2.0 (1.0-4.0) and 2.0 (1.0-3.0); and PD scores were 6.0 (2.0-9.0), 3.0 (1.0-6.0) and 2.0 (1.0-5.0), respectively 3.5±3.9 (Friedman test; p<0.0005 all). At baseline and 12 months, median Sharp -van der Heijde's scores were 16.0 (3.5-45.0) and 20.0 (6.0-51.0) (p<0.0005). A total of 79 patients (61.2%) experienced x-ray progression; 36 patients (27.9%) had no sign of x-ray progression and it was doubtful (progression =1) in 14 patients (10.9%). X-ray progression was not significantly associated with grey scale synovitis counts or scores for any cut-off between 0.5 and 5.5 but was significantly associated with PD counts for cut-offs of 0.5 (Se, 80.3 – 96.2; Sp, 16.7 – 42.4) and 1.5 (Se, 57.9 – 88.6; Sp, 16.7 – 42.4) as well as with PD scores for cutoffs of 0.5 (Se, 80.3 – 96.2; Sp, 16.7 – 42.4) and 1.5 (Se, 69.7 – 94.9; Sp, 27.8 – 55.6)ConclusionsPower Doppler joint counts or cumulative scores greater than 0.5 or 1.5 in a 12-joint PDUS assessment are significantly associated with X-ray progression. Cutoff of 1.5 performed slightly better for PD-scores than for PD-counts. Grey scale synovitis counts or scores were not significantly associated with X-ray progressionAcknowledgementsThe authors wish to thank Jesus Garrido for providing medical writi...