POS0572\u2005THE ASSOCIATED FACTORS OF ULTRASONOGRAPHIC TENOSYNOVITIS IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REMISSION

Abstract

Tenosynovitis is a common manifestation of rheumatoid arthritis (RA), but, is difficult to assess appropriately by clinical examination. In clinical remission, musculoskeletal ultrasound (MSUS) showed a predictive value of tenosynovitis for flares and joint destruction in RA (1).To assess the prevalence, the characteristics, and the factors associated with tenosynovitis in ultrasound examination of patients with RA in clinical remission.A Cross-sectional study including patients with RA in clinical remission (DAS28 ESR ≤ 2.6) for at least 6 months. MSUS of 20 tendons (in wrists, hands and ankles) was performed in mode B and power Doppler (PD). Tenosynovitis was defined and scored according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT). A total score for the tenosynovitis in B-mode (TBI) and PD (TDI) was calculated by summing the grades for each patient. SDAI and CDAI were calculated. Functional disability was assessed by the Health Assessment Questionnaire (HAQ). For the radiographic evaluations, we used the Van der Heijde score.Thirty-seven patients were enrolled, the mean age was 54.2 years±12.7 years and the sex ratio was 0.37. The mean disease duration was 8.1 years±5.1. The mean remission duration was 36.5 months ± 32.7. The prevalence of tenosynovitis was 40.5% in B-mode and 13.5% for PD. The most affected tendons were: extensor carpi ulnaris (B-mode: 21.6%, PD: 8.1%), tibialis posterior (B-mode: 10%, PD: 2.7%), peroneal (B-mode: 8.1%, PD: 2.7%), flexor digitorum superficialis and profundus (B-mode: 5.4%, PD: 0%) and extensor digitorum (B-mode: 2.7%, PD: 2.7%). Tenosynovitis was most frequently grade1 in B-mode (32.4%) and grade 2 in PD (10.8%). Grade 3 was identified only in B-mode in the peroneal tendons. The mean of TBI was 7.1±5.3 and the mean of TDI was 2.2.±3.1. We found a significant association between remission duration and PD tenosynovitis (mean: 16.2 vs 39.7 months, p = 0.05). Tenosynovitis, in B-mode and PD, weren’t associated with the swollen joints, the tender joints, the patient global health assessment, the HAQ, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor and anti-cyclic citrullinated peptide, DAS28, CDAI, SDAI, biologic treatment and radiographic structural damage. Multivariate logistic regression analysis didn’t show any association.Ultrasound tenosynovitis was commonly found in RA in remission and the extensor carpi ulnaris tendon was most involved. A shorter duration of remission was associated with PD tenosynovitis in univariate analysis. The MSUS assessment of tendons can be an additional feasible method to assess clinical remission.[1]Janta I, Stanciu D, Hinojosa M, Nieto-González JC, Valor L, Bello N, et al. Structural damage in rheumatoid arthritis: comparison between tendon damage evaluated by ultrasound and radiographic damage. Rheumatology (Oxford). 2016;55(6):1042-6.None declared