Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Comparison of Ultrasound & Physical Findings (CUSP) Remission StudyUltrasound Remission Is Attained in Only 20 of Patients on Anti-TNF Therapy.

Kitchen1,  Joanne M., Lynch3,  Bernadette M., FitzGerald2,  Oliver M., Veale3,  Douglas J., Kane1,  David

Adelaide and Meath Hospital, Dublin, Ireland
St Vincents Univ Hospital, Ranelagh Dublin, Ireland
St Vincents Univ Hospital, Dublin, Ireland

Background:

Studies show persistent inflammation on imaging in a proportion of patients in clinical remission on traditional DMARDs. This study aimed to evaluate clinical remission in patients on anti-tumour necrosis factor alpha (anti-TNF) drugs using objective measurement with DAS scores & ultrasound scoring using gray scale (GS) & power Doppler (PD) imaging.

Methods:

Patients with Rheumatoid (n=29) and Psoriatic arthritis (n=12) on anti-TNF therapy & deemed by their supervising clinician to be in remission were assessed. Patient joint counts were performed. C-reactive protein (CRP) was measured and DAS28CRP was calculated. Visual analogue scales (VAS) (pain, general wellbeing) & Health Assessment Questionnaires (HAQ) were completed. Ultrasound examination of the DAS28 joint set and of the ankles and metatarsophalangeal joints was performed (GE Logiq 9) with a high frequency (15MHz) linear array transducer. GS and PD synovitis were graded using an established semi-quantitative scale (0–3).

Results:

The mean disease duration was 9.9 years (range 2–30) & mean patient age was 56 years (range 33–75). Average duration of biologic therapy was 31.5 months (4–67) and 95% were on their first biologic. Mean DAS28CRP was 2.57 (1.35–4.85) while mean DAS28 was 2.74 (0.91–4.9). 21/41(51%) of patients were in DAS28CRP remission, 14 had low disease activity (DAS28CRP >2.6, <3.2) while 5 patients had active disease. Mean HAQ score was 0.58 (0–1.63). 34/41 (83%) had GS synovitis of at least Grade 2 in one joint, while the remainder (7/41, 17%) had Grade 3 synovitis in at least one joint. All patients had positive PD signal in at least one joint. Mean total score of PD was 19 (range 2–64). 22/41 (54%) patients had Grade 2 PD and 4/41 (10%) had grade 3 PD. If PD remission was defined as PD total score of 10 or less, 9/41 pts (22%, mean 6.4, range 2–10) fulfilled criteria. If PD remission was defined as PD total score of 5 or less, 4/41 pts (10%, mean 3.75, range 2–5) fulfilled criteria. GS and PD synovitis scores were significantly positively correlated with DAS28CRP (r=0.575 and r= 0.793 respectively, p<0.01 for both).

Percentage of patients in Remission

Conclusion:

Ninety percent (37/41) of patients in clinical remission & 81% (17/21) of patients in DAS remission on anti-TNF show persistent inflammation on GS & PD imaging. Standard clinical assessment alone is insufficient to determine remission in patients on anti-TNF therapy. Formal DAS28 scores should be performed routinely to ensure therapeutic response is adequate. Ultrasound assessment of remission reveals ongoing inflammation in patients in clinical remission.

To cite this abstract, please use the following information:
Kitchen, Joanne M., Lynch, Bernadette M., FitzGerald, Oliver M., Veale, Douglas J., Kane, David; The Comparison of Ultrasound & Physical Findings (CUSP) Remission StudyUltrasound Remission Is Attained in Only 20 of Patients on Anti-TNF Therapy. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1631
DOI: 10.1002/art.29396

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