Absence of correlation between DAS28-ESR, DAS28-CRP, SDAI, CDAI and ultrasound scoring in patients with rheumatoid arthritis in remission

Author(s): Melanie Trabelsi, Marion Cugnet, Athan Baillet, Marine Clay, Stephanie Rouanet, Elise Contant, Muriel Piperno, Florence Merle-Vincent, Deborah Gensburger, Claire Vidon, Hubert Marotte, Beatrice Pallot-Prades, Delphine Denarie, Adamah Amouzougan, Anne Cherasse, Laurent Grimault, Clementine Fortunet, Marie Bossert, Xavier Guillot, Isabelle Brault, Benoit Auge, Elodie Constant, Philippe Gaudin & Paul Ornetti

Objective: Several composite scores (28-joints Disease Activity Score (DAS28), Simplified/Clinical Disease Activity Index (SDAI/CDAI)) may be used as target of therapeutic strategies in rheumatoid arthritis (RA) management. Although ultrasound (US) is a useful imaging technique in RA management, there are no validated US remission criteria. We aimed at analyzing correlations between US and clinical scores in RA patients with clinical remission. Methods: This French multicenter cross-sectional study, in 11 Rheumatology departments, consecutively included patients from August 2015 to April 2016. Inclusions criteria were: RA diagnosis meeting ACREULAR 2010 criteria, <15 years of progression, DAS28-ESR<2.6 for at least 3 months, stable treatment for at least 6 months, including steroids if necessary. Correlations between US scores (Naredo12 B-mode, PD-mode, combined B+PD mode, PDUS scores) and clinical remission composite scores (DAS28-ESR (Erythrocyte Sedimentation Rate), DAS28-CRP (C Reactive Protein), SDAI, CDAI) were analyzed. Results: 225 patients were analyzed. Intra/inter-observer reliabilities were good to excellent. Correlations between clinical and US Naredo12 scores were weak to moderate, with correlation coefficients ranging from 0.086 [-0.05; 0.21] to 0.323 [0.20; 0.44]. Best correlations were observed between PD-mode and SDAI or CDAI. US Naredo12 PD-mode score of 0/36 predicts a SDAI remission with 78% sensitivity and 49% specificity (area under curve 0.65). No association was found between US Naredo12 scores and type of treatment, remission duration or disease duration. Conclusions: There is no strong correlation between US and clinical scores in remission RA patients in routine care. US input in the definition of RA remission remains uncertain.

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