INDICATIONS AND THERAPEUTIC IMPLICATIONS OF HAND AND WRIST JOINT ULTRASOUND IN RHEUMATOID ARTHRITIS

BackgroundUltrasound (US) has been increasingly used in the recent years for the diagnosis and follow-up of rheumatoid arthritis (RA) [1]. It is considered as a complement to physical examination with high sensitivity, specificity, and accuracy in detecting synovial thickening, synovial hypervascularization as well as cortical bone erosions [2].ObjectivesWe aimed to study the indications of hand and wrist joint ultrasound and the implications of its findings on the management of RA.MethodsA cross-sectional study was conducted on a sample of RA patients, fulfilling the ACR/EULAR 2010 RA classification criteria. We collected data about characteristics of the disease, its activity assessed by the Disease Activity Score 28 using C-Reactive Protein and erythrocyte sedimentation rate (DAS28-CRP, DAS28-ESR), treatment of RA (conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), biologics (bDMARDs), and corticosteroids (CS)), indication of hand and wrist joint US and the implications of its findings.ResultsFifty-eight patients were enrolled in the study with 83% females, with a mean age of 58.5±11.8 years and a mean age at diagnosis of 46.8±12. years. RA was seropositive in 89.7% of patients and erosive in 84.5%. Most patients underwent csDMARDs treatment (67.3%), 29.3% underwent bDMARDs treatment, and 67.3% used oral CS with a mean dose of 4.9±4.4 mg/day of prednisone equivalent. Mean DAS28-CRP was 4.1±1.4, and mean DAS28-ESR was 4.9±1.5.Hand and wrist joint US was performed for RA activity assessment in 93.1% of patients (n=54), for erosion assessment in recently diagnosed RA in 5.2% of patients (n=3), for erosion assessment in established RA in 1.7% of patients (n=1).In patients who had US signs of active RA, treatment was modified in 73% of patients with initiation of a 3-day parenteral CS pulses (18.9%), initiation of oral CS (2.7%), escalation of oral CS dose (2.7%), escalation of csDMARD’s treatment (24.3%), adjunction of another csDMARD (5.4%), reintroduction of a csDMARD (2.7%), initiation of bDMARDs (24.3%), and switch of bDMARDs (5.4%). US findings had no implication in 27% of these patients. When inactive RA was assessed (31,5%), there was no implication on treatment strategy in 82.4% of patients, a decrease of oral CS dose in 11.8% and a single intra-articular CS injection in 5.9%.Detecting ultrasonographic activity signs of RA in hand and wrist joint was more likely to have implications on treatment strategy than finding no activity signs (75% vs 22%, χ2=14.25, p<10-3).The group of patients who had an implication of US findings on treatment strategy had significantly higher DAS28-ESR (5.53 vs 4.18, p=0.002).ConclusionHand and wrist US had significant implications on treatment strategy of RA especially in patients with higher disease activity. However, it had no implications in some patients suggesting the complementary role of US compared to clinical determinants in RA treatment decision.References[1]do Prado AD, Staub HL, Bisi MC, da Silveira IG, Mendonça JA, Polido-Pereira J, et al. Ultrasound and its clinical use in rheumatoid arthritis: where do we stand? Advances in Rheumatology. 2018 Aug 2;58(1):19.[2]Ceponis A, Onishi M, Bluestein HG, Kalunian K, Townsend J, Kavanaugh A. Utility of the Ultrasound Examination of the Hand and Wrist Joints in the Management of Established Rheumatoid Arthritis. Arthritis Care & Research. 2014;66(2):236–44.Disclosure of InterestsNone declared