LAUSR

Background Ultrasound (US) examination is able to show subclinical synovitis and structural changes of joints in patients (pts) with RA in clinical remission (CR). Objectives To investigate the differencies of US examination of small joints of hands, feet and wrists in pts with very early (VERA, <1y) vs early (ERA, <3y duration) vs long lasting RA (LRA, >7 y duration) in clinical remission (CR). Methods In 2015 an educational event (RECALL survey) focused on the added value of US in RA pts was held in 22 rheumatology centers in Italy. In every center, the local rheumatologists provided RA pts to be examined by US. Pts signed an informed consent and a brief history of them was collected by the local rheumatologists (previous and current therapy, DAS28, HAQ score). Bilateral US examinations of wrists, metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints were performed by rheumatologists expert in US, to assess synovitis (joint effusion, synovial proliferation, and power Doppler (PD) signal), and bone erosions, using a Logiq E R7, General Electrics, with a 4.2–13 MHz linear probe. All US findings were scored using a 4 degree semiquantitative scoring system. Results Eighty-eight pts were classified as VERA, 183 as ERA and 165 as LRA. Drug usage was not different among the three groups of pts. LRA patients were older (p<0.001), had longer disease remission before US examination (p<0.001) and had an higher prevalence of female sex (p<0.01). Table 1 reports the differences of US examination between VRA vs ERA vs LRA patients. LRA patients had more erosions at MTP and wrists with no differences at MCP joints. Synovial hypertrophy and PD signal had the same degree and distribution in the two groups of patients. LRA patients had more MTP joints with effusion with lower degree as compared to patients with ERA and VERA (see table 1).Table 1 VERA (A) VERA+ERA LRA (C) p 88 pts 183 pts 165 pts M/F 25/63 58/125 22/143 A vs C = 0.002 B vs C = <0.001 Number of pts aged <50y 30/88 58/183 21/165 A vs C = <0.001 B vs C = <0.001 % of pts with remission <12 months 85 80 48 A vs C = <0.001 B vs C = <0.001 % of pts with >1 eroded joint 39 54 62 A vs C = <0.001 B vs C = <0.001 % of pts with >1 joint with synovial hypertrophy 69 71 73 A vs C = ns B vs C = ns % of pts with synovial hypertrophy >1 46 49 51 A vs C = ns B vs C = ns % of pts with >1 joint positive for PD signal 48 50 45 A vs C = ns B vs C = ns % of joints with PD signal >1 32 34 35 A vs C = ns B vs C = ns % of pts with effusion at MTP joints 45 49 59 A vs C = 0.034 B vs C = 0.044 % of pts with MTP joints effusion >1 25 21 12 A vs C = 0.010 B vs C = 0.023 Conclusions At US examination VERA, ERA and LRA pts in CR have the same degree of synovial hyperplasia and PD signal despite the differences of duration of CR. Higher degree of erosive disease (at wrist and MTP joints), lower degree of MTP effusion and higher prevalence of joint effusion at MTP joints were present among LRA vs ERA and VERA pts. Disclosure of Interest None declared