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.


Ultrasonography at the Onset of Early Arthritis Predicts Joint Erosions at One Year: Results of the ESPOIR Cohort Ultrasound Study.

Funck-Brentano4,  Thomas, Gandjbakhch4,  Fréderique, Etchepare4,  Fabien, Jousse2,  Sandrine, Lukas3,  Cedric, Foltz4,  Violaine, Saraux2,  Alain

Amiens
Brest Universitary Hospital
Immuno-rhumatologie, Hopital Lapeyronie, Montpellier, France
Rheumatology Department, Pitié-Salpetrière Hospital, Paris 6 University, France
Tours Universitary Hospital

Background:

Ultrasonography (US) has been shown highly sensitive to detect erosions at baseline, compared to conventional radiography (CR). However, only few longitudinal studies have investigated its capacity to predict future structural damage.

Objective:

to assess the predictive value of US for future radiographic erosion on the same joint based on the ESPOIR cohort data.

Methods:

ESPOIR is a nationwide early arthritis cohort that included between 2002 and 2005 813 early arthritis patients.

US was performed at baseline on 127 patients from the ESPOIR cohort in 4 centers at baseline. US characteristics: 10–13MHz linear array transducer; Power Doppler (PD): frequency of 8.3MHz and pulse repetition frequency of 750Hz. US was performed blindly from clinical and radiological findings. Targeted joints were MCP2&5 and MTP5 for erosion detection, MCP2 to 5 and MTP5 for synovitis (gray scale and power Doppler). CR of the hands, wrists and feet at baseline and one year were read by one investigator according to the van der Heijde modified Sharp score. Baseline US findings associations with joint erosions on CR at one year were tested in univariate analyses using two-by-two tables and Pearson's chi-square tests. Predictive factors for joint erosion at one year by CR were tested in multivariate analysis including age, DAS28, CRP, ESR, positivity for Rheumatoid factor (RF) and anti-CCP and corticotherapy, using a mixed procedure.

Results:

Patients characteristics at baseline were (mean ± sd or %): age 50.3 ± 12.2; Female 77.2%; DAS28 5.1± 1.3; number swollen joints 7.8±5.6; number tender joints 7.4±6.4; ESR 31.2±24.0mm; CRP 19.8±32.9 mg/l; Anti-CCP antibody positive 46.8%; Rheumatoid factor (RF) positive 35.4%. CR data at one year was obtained on 1184 joints that had mode B and PD evaluation and 708 joints for US erosions. CR erosions at one year: 105(8.9%) joints were erosive by CR on the 10 targeted joints. In univariate analysis, baseline PD positive synovitis and US erosions were associated with the presence of a CR erosive joint at one year. After adjustment for the clinical and biological variables, US erosions at baseline remained predictive of the presence of CR erosive joints at one year, independently from CRP and the presence of RF, also significantly associated (p<0.001).

Table 1. Baseline US characteristics for the presence of CR erosion at one year:

Prediction of future joint damage on X-ray at 1 year
   X-Ray findings at year 1
   Eroded jointNoneroded jointOR (unadjusted)OR (adjusted)*
US findings at baselineUS Synovitis (N = 1184)Joint with Doppler+ synovitis32/105 (30.4%)196/1077 (18.2%)1.97 [1.26–3.07]1.79 [1.00–3.19]
 US Erosion (N = 708)Eroded joint21/71 (29.5%)57/635 (9.0%)4.26 [2.39–7.59]3.12 [1.65–5.87]
* Adjustment for age, DAS28, CRP, ESR, positivity for Rheumatoid factor (RF) and anti-CCP and corticotherapy

When restricted to CR non erosive joints at baseline, these associations were maintained (PD synovitis: OR=5.41[2.09–14.01];p<0.001; US erosion: OR=3.93;[1.35–11.43];p=0.012). When restricted on non erosive patients on baseline CR, US erosions became borderline significant (p=0.052).

Conclusion:

At the joint level, baseline US findings are associated with structural damage at one year. US is a reliable and useful technique to predict future erosions in early arthritis patients.

To cite this abstract, please use the following information:
Funck-Brentano, Thomas, Gandjbakhch, Fréderique, Etchepare, Fabien, Jousse, Sandrine, Lukas, Cedric, Foltz, Violaine, et al; Ultrasonography at the Onset of Early Arthritis Predicts Joint Erosions at One Year: Results of the ESPOIR Cohort Ultrasound Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2221
DOI: 10.1002/art.29985

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