Ciurtin, C

Clarke, R

Manson, J

UCL Discovery

Medical or Research Professionals/CliniciansTopic area: Clinical topics by area of researchSpecific topic: 31. Diagnostics and imaging proceduresEULAR14-SCIE-4440A SIGNIFICANT PROPORTION OF PATIENTS WITH NEWLY DIAGNOSED AND ESTABLISHED INFLAMMATORYARTHRITIS HAVE POSITIVE DOPPLER SIGNAL IN THEIR HAND JOINTS IN THE CONTEXT OF NORMAL C-REACTIVE PROTEIN LEVELSRobert Clarke 1Jessica Manson 1Coziana Ciurtin 1,*1Rheumatology, UNIVERSITY COLLEGE LONDON, London, United KingdomMy abstract has been or will be presented at a scientific meeting during a 12 months period prior to EULAR 2014: NoIs the first author applying for a travel bursary?: YesIs the first author of this abstract an undergraduate medical student?: YesBackground: Ultrasound (US) assessment of small joints is a well-established method of investigation in inflammatory arthritis.Previous data suggest that there is a poor correlation with clinical examination, and has proved that US is useful in detectingsubclinical inflammation (1). Objectives: Our aim was to establish the proportion of inflammatory arthritis (IA) patients (newly diagnosed or established) withactive synovitis detected by US in the context of normal CRP.Methods: We conducted a real life study in patients with IA using a standardised US examination of 22 hand joints. We received276 referrals between February and August 2013 and we assessed these patients for evidence of active synovitis based on thepresence of Doppler signal. There were 108 patients with established rheumatoid arthritis (RA), 93 were referred for the clinicalsuspicion of inflammatory arthritis (IA), and the rest had other diagnoses. All the patients reported inflammatory symptoms in theirhands and their clinical examination was equivocal. We report data on the two largest groups, the RA and IA groups, usingdescriptive statistics (Origin 6.0). P < 0.05 was considered statistically significant.Results: We found positive Doppler signal in 143 patients, and 76 (53.14%) of these have normal CRP level, as measured 2.8 +/-1.6weeks prior or post US examination. There were 41 RA in this group (from a total of 83 found with positive Doppler signal) and theirdisease duration was 12+/-10.2 years. Of these, 66% had positive rheumatoid factor (RF) and 63% had positive anti citrullinatedpeptide antibodies (ACPA).  There were 23 patients referred for the suspicion of IA with positive Doppler signal and normal CRP outof 52 found with active synovitis, having a median duration of symptoms of 6.8 months+/-1.9. However, the proportion ofseropositive patients – 21.7% for RF and 17.3% for ACPA - was significantly decreased compared to the RA group (p = 0.001). Themedian number of joints with Doppler signal was 3+/-0.54 in the RA group and 3+/- 0.31 in the IA group (p=0.12). The number oftender joints (out of 28) was 10.6+/-8.6 and 9.2+/- 7.5 in the RA and IA groups respectively (p=0.07). RA patients had significantlyincreased number of swollen joints (5.21+/-3.01 vs. 3.95+/-3.2, p=0.03), but the IA group of patients reported a significantly lowerglobal health state than the RA patients (66.25+/- 22 vs. 50.5+/- 33.2, p= 0.02). The number of clinically assessed swollen jointscorrelated poorly with the presence of Doppler signal in RA and IA patients (r=0.27 and r=0.42, respectively).Conclusions: Normal CRP levels could be found in patients with active joint inflammation in similar proportions in patients withestablished RA (49.3%) and newly diagnosed with IA (44.2%). However, in the RA group there were more swollen joints that did notcorrelate with the presence of Doppler signal. The newly diagnosed patients with IA reported a lower health state, despite objectiveevidence of similar numbers of inflamed joints as the RA patients. US examination of hands is a suitable tool for active synovitisdetection in symptomatic patients with normal CRP levels and equivocal clinical evidence of joint swellings. References: Saleem, B et al., Arthritis Rheum. 2009 Jul;60(7):1915-22.  Disclosure of Interest: None declared

A Significant Proportion of Patients With Newly Diagnosed and Established Inflammatory Arthritis Have Positive Doppler Signal in Their Hand Joints in the Context of Normal C-reactive Protein Levels

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A Significant Proportion of Patients With Newly Diagnosed and Established Inflammatory Arthritis Have Positive Doppler Signal in Their Hand Joints in the Context of Normal C-reactive Protein Levels

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