THU0072 ULTRASOUND PREDICTS IMMINENT PROGRESSION TO ARTHRITIS IN ANTI-CCP POSITIVE AT-RISK INDIVIDUALS

Background Ultrasound (US) Power Doppler (PD) signal is predictive for the development of inflammatory arthritis (IA) in anti-cyclic citrullinated protein antibodies positive (CCP+) individuals with musculoskeletal (MSK) symptoms but no clinical synovitis (CS) [1]. Our previous data showed a late increase in the overall US inflammation before arthritis development, suggesting that a sub-clinical phase of synovitis could be detected [2]. This abstract describes the prediction of PD abnormalities in the months following US scan. Objectives 1. Presence of PD in one joint is predictive of imminent progression to IA in the next 3months. 2. A rise in the number of joints with presence of PD increases the odds of progression to IA. Methods In a single-centre prospective observational cohort between June 2008 and December 2018, 307 CCP+ patients with a new MSK symptom but no synovitis were followed until CS occurred. Clinical and US findings were analysed. Following our previous study, we compared progression in the 3, 12 or >12 months after a US scan. 38 joints were included in the analysis (MTPs, hands, wrists, elbows, ankles and knees). Patients with palindromic rheumatism were excluded. Results Data from 96 CCP+ at-risk patients who developed CS (progressors) are compared to 211 CCP+ patients who did not (non-progressors). Age and gender are similar, the mean follow-up of the non-progressors is higher, with significantly more smokers and high titre CCP in the progressors group (Table1). Overall, progressors have more joints with PD than non-progressors (Figure1). Patients with PD in one joint are more likely to develop CS in the following 3 months compared to those without PD (OR 7.52) and this remain significant when only the hands and wrists are included (Table2). The highest OR is shown when PD≥2 is found in at least one wrist. Similarly, there is a significant but smaller prediction of progression between 3 to 12 months after US (Table2). When a new joint develops PD, the likelihood of progression to IA within the next 3 months increases (Table2). This is especially predictive with wrists involvement (OR 3.10). Prediction of progression between 3 to 12 months before CS is significantly different between groups, with a higher OR for the wrists. Conclusion The presence of PD in one joint and every new joint with PD are both predictive of progression to IA within the next 3months. These results should lead to a logical programme for therapy and follow -up. References [1] Nam J. et al., US findings predict progression to inflammatory arthritis in anti-CCP positive patients without CS. Ann Rheum Dis, 2016. 75(12). [2] Pentony P, et al., Sequential US shows a late increase in inflammatory burden in anti-ccp positive patients with non-specific MSK symptoms just before progression to IA. Ann Rheum Dis, volume 77, year 2018 Disclosure of Interests Laurence Duquenne: None declared, Kulveer Mankia Grant/research support from: Research support from BMS and Lilly, Speakers bureau: Honoraria from Abbvie, UCB, Jacqueline Nam: None declared, Peta Pentony: None declared, Leticia Garcia-Montoya: None declared, Andrea DiMatteo: None declared, Laura Hunt: None declared, Paul Emery Grant/research support from: Pfizer, MSD, AbbVie, Bristol-Myers Squibb, Roche, Consultant for: Pfizer, MSD, AbbVie, Bristol-Myers Squibb, UCB, Roche, Novartis, Gilead,Samsung, Sandoz and Lilly