Coziana Ciurtin
University College London, UK
Posters & Accepted Abstracts: Rheumatology (Sunnyvale)
Management of rheumatoid arthritis (RA) incorporates a treat-to-target approach with the aim of achieving clinical remission as soon as possible. Advances in musculoskeletal ultrasound (MSK US) technology and the increasing number of rheumatologists trained in this skill have increased the popularity of ultrasound (US) as an objective measure of inflammation in RA and questioned the reliability of DAS-28 assessment in current practice. We performed a prospective, cross-sectional study, which evaluated patients with inflammatory pain in their hands and feet in the context of various rheumatic conditions. The most relevant findings of this study were demographic parameters and clinical examination did not distinguish between the RA patients and non-rheumatoid control group; DAS-28 did not correlate with US outcome measures in RA patients and did not help differentiate patients with subclinical synovitis versus well-controlled disease as there was no statistically significant correlation between any of the US outcomes and DAS-28 score; there was a significant burden of foot synovitis in RA patients as over one third (35.2%) of our patients in the RA cohort were found to have active foot disease on US, as defined by a PD of â?¥ 1, despite clinical examination unable to assess for the presence of foot synovitis and irrespective of patientsâ?? DAS-28 score; US examination of feet (in addition to hands) improved the sensitivity of US for diagnosis of active synovitis in RA patients in remission and with low and moderate disease activity. All the RA patients with active synovitis in their feet alone were classified by DAS-28 as being in remission or having low disease activity. Further research into improved long term outcome of RA patients using this extended US small joint protocol versus clinical examination and DAS-28 assessment is needed to assess its potential clinical utility in routine practice.
E-mail: c.ciurtin@ucl.ac.uk
