Ab0192 analysis of ultrasound findings in patients with difficult to treat rheumatoid arthritis

Background In recent years, the concept of D2TRA (difficult-to-treat rheumatoid arthritis) has become widespread, and D2TRA patients are defined as a state in which activity cannot be controlled even with the use of various molecular-targeted drugs. In this study, we investigated the ultrasound synovial findings in D2TRA patients. However, ultrasound findings in D2TRA patients are unknown. Objectives In this study, we investigated the ultrasound findings of D2TRA patients. Methods A total of 750 RA patients who underwent ultrasound examination were included. Ultrasond examination was performed at the of bilateral first to fifth metacarpophalangeal (MCP) joints, first interphalangeal (IP) and second to fifth proximal interphalangeal (PIP) joints, wrist joints (three part of radial, medial and ulnar) and first to fifth metatarsophalangeal (MTP) joints. Of all 750 RA patients, 517 RA patients (68.9%) who treated bDMARDs/JAKi were included and devided in D2TRA patients and non-D2TRA patients. The patients‘ characteristics, total gray scale (GS) and power Doppler (PD) score (GSUS/ PDUS) were compared between D2TRA patients and non-D2TRA patients. Results There were 40 D2TRA patients and 477 non-D2TRA patients. Mean age was 61.2 vs. 65.0 years (p=0.133), mean disease duration of RA was 17.6 vs. 14.9 years (p=0.199), CDAI was 12.6 vs. 9.8 (0.166), and CRP level was 0.79 vs. 0.28 mg/dL (p=0.233), MMP-3 level was 295.6 vs 10.8ng/mL (p=0.057), respectively. In the D2TRA group, concomitant use ratio of MTX was low (50.0 vs 70.9 %, p=0.011), but there was no difference in the average dose of MTX (8.9 vs 9.2 mg/w, p=0.581). The concomitant use ratio of glucocorticoid (32.5 vs 12.6 %, p=0.002) and the average dose of glucocorticoid (7.7 vs 3.1 mg/d, p=0.003) were higher in D2TRA group. Regarding ultrasound findings, GSUS score (16.2 vs 9.5, p=0.011) and PDUS score (11.0 vs 6.4, p=0.034) were significantly higher in the D2TRA group. Table 1. D2TRA (n=40) non D2TRA (n=477) p value Age (years) 61.2±17.3 65.0±14.1 0.113 Female, % 77.5 82.1 0.390 BMI (kg/m 2 ) 22.5±4.9 22.3±3.4 0.750 Disease duration (years) 17.6±9.6 14.9±12.7 0.199 RF+, % 95.0 89.9 0.410 RF titer (mg/dL) 754.3±1284.7 301.2±423.4 0.032 CCP+, % 94.8 85.2 0.144 CCP titer (U/mL) 227.0±183.2 134.0±165.6 0.001 MTX use, % 50.0 70.9 0.011 MTX dose (mg/week) 8.9±2.6 9.2±3.6 0.581 Glucocorticoid use, % 32.5 12.6 0.002 Glucocorticoid dose (mg/day) 7.7±4.4 3.1±1.8 0.003 DAS28 ESR 3.2±1.9 3.0±1.4 0.668 DAS28 CRP 2.8±1.4 2.7±1.2 0.438 SDAI 13.4±12.6 10.1±9.5 0.120 CDAI 12.6±12.0 9.8±9.3 0.166 HAQ 0.90±0.98 0.66±0.74 0.137 ESR (mm/h) 26.2±30.2 17.6±20.6 0.085 CRP (mg/dL) 0.79±2.67 0.28±0.77 0.233 MMP-3 (ng/mL) 295.6±611.9 105.8±157.2 0.057 GSUS 16.2±15.7 9.5±9.5 0.011 PDUS 11.0±13.0 6.4±7.7 0.034 Conclusion The definition of D2TRA is resistant to multiple mode of bDMARDs/JAKi. Although, disease activity and inflammatory markers tended to be worse in the D2TRA group, there was no statistically significant difference in this study. However, ultrasound findings were significantly worse in D2TRA. Suppression of synovitis might be important to prevent D2TRA. Reference [1]Watanabe R, Okano T, Gon T, Yoshida N, Fukumoto K, Yamada S, Hashimoto M. Difficult-to-treat rheumatoid arthritis: Current concept and unsolved problems. Front Med (Lausanne). 2022 Oct 24;9:1049875. Acknowledgements: NIL. Disclosure of Interests Tadashi Okano Speakers bureau: Abbvie, Chugai, Eli Lilly, Janssen and Novartis Pharma, Grant/research support from: Abbvie, Asahi Kasei, Chugai, Eisai, Eli Lilly and Tanabe Mitsubishi, Kenji Mamoto: None declared, Yutaro Yamada: None declared, Shohei Anno: None declared, Asami Yagami: None declared, Yuka Domae: None declared, Shingo Washida: None declared, Yuko Yoshida: None declared, Tatsuya Koike: None declared, Hiroaki Nakamura: None declared.