Ultrasound-detectable grey scale synovitis predicts future fulfilment of the 2010 ACR/EULAR RA classification criteria in patients with new-onset undifferentiated arthritis - PubMed (original) (raw)

Ultrasound-detectable grey scale synovitis predicts future fulfilment of the 2010 ACR/EULAR RA classification criteria in patients with new-onset undifferentiated arthritis

Sarah C Horton et al. RMD Open. 2017.

Abstract

Objective: To determine the clinical outcomes for patients with new-onset undifferentiated arthritis (UA), not fulfilling the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) classification criteria, and the clinical and imaging predictors of disease progression in these patients.

Methods: A prospective observational study was conducted in treatment-naïve UA patients. Baseline ultrasound involved semiquantitative assessment of grey scale (GS) synovitis and power Doppler activity (PD) at 26 joints. Outcomes were fulfilment of 2010 RA criteria (joint involvement determined clinically) and initiation of methotrexate over 12 months. Cox proportional hazards analysis was used to investigate predictors of outcome.

Results: Of 60 patients, 13(22%) progressed to RA and 32(53%) ever received methotrexate. Analyses of predictors of outcome were conducted in the subgroup (n=41) of patients with complete baseline data. The presence of GS was associated with progression to RA and methotrexate use: HRs (95% CI) were 1.25(1.07 to 1.45) and 1.16(1.02 to 1.32), respectively, for the number of joints with GS≥ grade 2 after adjustment for swollen joints. PD was not predictive in the low levels at which it was observed. Progression to RA was also associated with fulfilment of the 2010 criteria using ultrasound synovitis for enumerating joint involvement, higher baseline disability and radiographic erosion.

Conclusions: This is the first report of ultrasound findings in early UA (defined by presence of clinical synovitis and non-fulfilment of 2010 RA criteria). A significant proportion of patients with UA progressed to RA and/or required methotrexate. GS synovitis was predictive of disease progression.

Keywords: Arthritis; Early Rheumatoid Arthritis; Synovitis; Ultrasonography.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Figure 1

Spectrum of ultrasound grey scale on the dorsal aspects of the wrists ((a) to (d)), MCPs ((e) to (h)), PIPs ((i) to (l)) and MTPs ((m) to (p)): grade 0 ((a), (e), (i) and (m)), grade 1 ((b), (f), (j) and (n)), grade 2 ((c), (g), (k) and (o)) and grade 3 ((d), (h), (l) and (p)). Courtesy of J. L. Nam et al, Leeds, reproduced with permission from Annals of the Rheumatic Diseases. C, capitate; L, lunate; MC, metacarpal; MCPs, metacarpophalangeal joints; MP, middle phalanx; MT, metatarsal; MTP, metatarsophalangeal joints; PIPs, proximal interphalangeal joints; PP, proximal phalanx; R, radius.

Figure 2

Figure 2

Patient disposition.

Figure 3

Figure 3

Kaplan-Meier survival plots for survival without: (A) progression to RA according to the number of joints with significant synovitis defined by GS≥ grade 2 at any of 26 joints, or (B) GS= grade 3 at MTPs 1–5 or ≥ grade 2 at any other joint, (C) the need for methotrexate according to the number of joints with significant synovitis defined by GS≥ grade 2 at any of 26 joints. The number of patients per group at baseline is denoted by n. GS, grey scale; MTP, metatarsophalangeal; RA, rheumatoid arthritis.

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References

    1. Aletaha D, Neogi T, Silman AJ et al. . 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62:2569–81. 10.1002/art.27584 - DOI - PubMed
    1. van der Heijde D, van der Helm-van Mil AH, Aletaha D et al. . EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria. Ann Rheum Dis 2013;72:479–81. 10.1136/annrheumdis-2012-202779 - DOI - PubMed
    1. Radner H, Neogi T, Smolen JS et al. . Performance of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis: a systematic literature review. Ann Rheum Dis 2014;73:114–23. 10.1136/annrheumdis-2013-203284 - DOI - PubMed
    1. Krabben A, Abhishek A, Britsemmer K et al. . Risk of rheumatoid arthritis development in patients with unclassified arthritis according to the 2010 ACR/EULAR criteria for rheumatoid arthritis. Rheumatology (Oxford) 2013;52:1265–70. 10.1093/rheumatology/ket011 - DOI - PubMed
    1. Cader MZ, Filer A, Hazlehurst J et al. . Performance of the 2010 ACR/EULAR criteria for rheumatoid arthritis: comparison with 1987 ACR criteria in a very early synovitis cohort. Ann Rheum Dis 2011;70:949–55. 10.1136/ard.2010.143560 - DOI - PubMed

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