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.


CRP-Levels and Duration of Morning Stiffness as Predictors of Active Rheumatoid Arthritis as Verified by Ultrasound in Routine Clinical Practice.

Dejaco5,  Christian, Duftner2,  Christina, Wipfler-Freibetamuth3,  Edith, Weiss4,  Helmut, Graninger5,  Winfried B., Schirmer1,  Michael

Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria
Department of Internal Medicine, General Hospital of the Elisabethinen Klagenfurt, Klagenfurt, Austria
Department of Internal Medicine, Hospital of the Barmherzige Brüder Marschallgasse Graz, Graz, Austria
Department of Radiology, General Hospital of the Elisabethinen Klagenfurt, Klagenfurt, Austria
Department of Rheumatology, Medical University Graz, Graz, Austria

Objective:

To identify clinical and serological parameters predicting active disease as verified by ultrasound in rheumatoid arthritis (RA) patients from routine clinical practice.

Methods:

Retrospective analysis of data from 149 consecutive RA-patients subjected to ultrasound (US) examination [mean disease activity score for 28 joints (DAS-28) 4.5 (standard deviation ± 1.3); mean age 63.7 (±13.4) years; 84.6% female; median disease duration 18 months]. Each patient underwent bilateral US assessment of wrists, metacarpo-phalangeal and proximal inter-phalangeal joints (=22 joints) for the assessment of synovial hypertrophy and/or effusion (SH/E) as well as synovial vascularization as determined by power Doppler (PD). According to Balsa A et al. sonographic remission was defined as the absence of PD-signals whereas presence of hypervascularisation indicated active disease[i]. The number of tender (TJ) and swollen joints (SJ), global assessment of disease activity on a visual analogue scale by the physician (VAS-phys) or patient (VAS-pt), C-reactive protein (CRP)-levels, erythrocyte sedimentation rate (ESR), duration of morning stiffness (MS), DAS-28, clinical disease activity index (CDAI), simplified disease activity index (SDAI) and health assessment questionnaires (HAQ) were recorded. This retrospective analysis was accepted by the local ethics committee.

Results:

Sonographically detected hypervascularization was observed in 117 (78.5%) of the RA-patients. CRP, ESR and MS were higher in patients with sonographic signs of disease activity than in those with remission [CRP: median 0.8 (inter-quartile range 2.1) vs. 0.3 (0.6) mg/dl, p=0.01; ESR: 24 (39) vs. 14 (16) mm/1st hour, p=0.019; MS: 30 (115) vs. 12.5 (30) minutes, p<0.001, respectively]. TJ- and SJ-count, VAS-phys, VAS-pt, ESR, DAS-28, CDAI, SDAI and HAQ were similar among both groups. None of the parameters differed between those 10 patients without sonographic lesion and the 22 patients showing SH/E but no PD-signals. Using backward logistic regression analysis we found an odds ratio (OR) of 3.8 (1.6–9.1, p=0.003) for CRP >5.0mg/L (normal values 0–5.0mg/L) and an OR of 1.6 (1.1–2.5, p=0.024) for MS >30min (interaction between these parameters not significant) to predict active disease. The other clinical and serologic parameters showed no association with disease activity.

Conclusion:

In routine clinical practice elevated CRP-levels and longer duration of MS alone are predictors of active RA as verified by ultrasound. This observation could be helpful for the development of referring strategies in the management of these patients.

[i]Balsa, A, de Miguel, E, Castillo, C, Peiteado, D & Martín-Mola, ESuperiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard. Rheumatology 2010; 49:):683-90.

To cite this abstract, please use the following information:
Dejaco, Christian, Duftner, Christina, Wipfler-Freibetamuth, Edith, Weiss, Helmut, Graninger, Winfried B., Schirmer, Michael; CRP-Levels and Duration of Morning Stiffness as Predictors of Active Rheumatoid Arthritis as Verified by Ultrasound in Routine Clinical Practice. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2222
DOI: 10.1002/art.29986

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