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Downloaded from http://ard.bmj.com/ on October 25, 2017 - Published by group.bmj.com
Scientific Abstracts
SAT0277
CLINICAL RESPONSE IN EARLY PSORIATIC ARTHRITIS
MAY BE PREDICTED BY RAPID REDUCTION OF A
SEMIQUANTITATIVE ULTRASOUND SYNOVITIS SCORE
A. P. Nigg1, A. M. Malchus1, M. Gruenke1, M. Witt1, J. Prinz2, H. SchulzeKoops1. 1Division Of Rheumatology, Med. Klinik und Poliklinik IV,
2
Dermatology, University Of Munich, Munich, Germany
Background: Accurate monitoring of disease activity in early PsA is limited
by the potential underestimation of inflammation by clinical examination and
the absence of disease-specific biochemical markers. Therefore, sensitive
and reliable diagnostic modalities enabling visualization of early inflammatory
changes are required as a diagnostic tool and for monitoring the response to
therapy.
Objectives: The aims of this longitudinal study were to analyse differences
of a semiquantitative ultrasound score between clinical responers and nonresponders during treatment of early PsA. Furthermore we tested if a rapid
reduction of ultrasound activity 3 months after initiation of DMARD treatment
allows prediction of long term disease outcome defined by MDA criteria
(minimal disease activity).
Methods: 51 patients were eligible for study inclusion, to date 18 patients
have completed a 3- and 6-month follow-up visits. Patients were evaluated by
ultrasound (US) and clinically at baseline and after 3, 6 and 12 months. In each
patient a total of 56 joints were examined by US. Grey-Scale (GS) and power
doppler (PD) US findings were scored separately on a 0-3 semi-quantitative
scale as previously described. The total US synovitis score was calculated
by adding the scores in the GSUS and PDUS modes for all joints examined.
Clinical assessment included a composite ACR joint count of 68 tender and
66 swollen joints, visual analog scale (VAS) for disease activity (patient and
physician), VAS for pain, DAS-28-CRP, Leeds dactylitis instrument, MASES,
HAQ, CRP, ESR and demographic data. Treatment was initiated and
modified according to the clinical decision of the treating rheumatologist and
dermatologist in agreement with international recommendations. Criteria for
MDA (minimal disease activity in PsA, Coates L. et al. Ann Rheum Dis 2010)
were defined for each follow-up period.
Results: Improvement of the semiquantitative synovits ultrasound score as
well as improvement of clinical and laboratory parameters after 3 months of
treatment was associated with fulfillment of MDA criteria at 6-month followup-Visit (OR, odds ratio): total US synovitis score (OR=9.0), PDUS sub-score
(OR=0.77), TJC68 (OR=9.0), SJC66 (OR=2.4), CRP (OR=infinite), HAQ
(OR=3.38), PGA (OR=2.4). In patients fulfilling the MDA criteria (6-monthsfollow up) the mean percentage change of the total US synovitis score after 3
month was -28.4% whereas non-responders showed a mean increase of the
score by 31.9%.
Conclusions: Changes in the GSUS and PDUS scores allow discrimination
between clinical responders and non-responders (defined by minmal disease
activity criteria, MDA). Changes of a semiquantitative ultrasound synovitis
score after 3 months of DMARD treatment are strongly associated with the
overall clinical activity after 6 months. The response measured by ultrasound
may therefore be predictive for a favourable long-term clinical outcome and
may allow early identification of patients with poor prognosis who might benefit
from treatment with biologics. Disclosure of Interest: None Declared
SAT0278
LEFT VENTRICULAR DYSFUNCTION ASSESSED BY
SPECKLE-TRACKING STRAIN ANALYSIS IN PATIENTS
WITH PSORIATIC ARTHRITIS PATIENTS WITHOUT
CLINICAL EVIDENCE OF CARDIOVASCULAR DISEASE
B. Yilmazer1, T. Şahin2, A. Çefle1. 1Dept. of Internal Medicine, Division of
Rheumatology, 2Dept. of Cardiology, Kocaeli University Medical Faculty,
Kocaeli, Turkey
Objectives: Psoriatic Arthritis (PsA) is a chronic inflammatory disorder. Its
etiology is unknown and it is associated with psoriasis. Endothelial dysfunction
and early atherosclerosis have been found a high prevalence in PsA patients.
Few studies have investigated whether there is any early impairment of
myocardial function. Conventional echocardiography parameters have limited
sensitivity to detect subtle myocardial dysfunction in patients with PsA. The
aim of this study was to assess, by using the novel technique, the presence of
myocardial dysfunction in patients with PsA.
Methods: 31 PsA patients without clinical evidence of CVD and 19 matched
(age, gender, body mass index, smoking status) healthy control subjects
were enrolled. All were undergone by conventional echocardiography, tissue
Doppler imaging and speckle-tracking strain analysis.
Results: Eight-teen (58%) patients with PsA had evidence of left diastolic
ventricular (LV) dysfunction as defined by septal E´<8 cm/s, and/or septal E/
E´>15. Thirteen patients (42%) had evidence of subclinical LH hypertrophy.
However, all PsA patients had normal left ventricular ejection fraction. In this
study, normal value was defined as >55%. Global longitudinal strains (−17.2
± 2.7% versus −19.3±2%; P < 0.05), circumferential strains (−14.23 ± 3.0%
versus −20.3 ± 4.7%; P = 0.0001), and radial strains (29.8 ± 9. 6% versus 46.5
± 17%; P =0.001) had been impaired in patients with PsA, as compared with
controls. Decreased global longitudinal, circumferential and radialstrains were
not associated with disease duration, disease pattern and subjects on diseasemodifying antirheumatic drugs (DMARDs) or on tumor necrosis factor(TNF)-α
in patients with PsA.
Saturday, 15 June 2013
677
Conclusions: PsA patients without established CVD have a high prevalence
of subclinical LV dysfunction. Speckle-tracking strain analysis can detect subtle
myocardial dysfunction in patients with PsA. The use of this novel imaging
technique may therefore improve risk stratification and monitoring of the
cardiovascular involvement in patients with PsA.
References: -Gladman DD. Psoriatic arthritis. In: Maddison PJ, Isenberg DA,
Woo P, Glass DN, Breedveld F, eds. Oxford textbook of rheumatology. 3rd ed.
Oxford: Oxford University Press, 2004:766–78.
- Eder L, Jayakar J, Shanmugarajah S, Thavaneswaran A, Pereira D, Chandran
V, Rosen CF, Gladman DD. The burden of carotid artery plaques is higher in
patients with psoriatic arthritis compared with those with psoriasis alone.Ann
Rheum Dis. 2012 Jun 26.
- Shang Q, Tam LS, Yip GW, Sanderson JE, Zhang Q, Li EK, Yu CM. High
prevalence of subclinical left ventricular dysfunction in patients with psoriatic
arthritis.J Rheumatol. 2011 Jul;38(7):1363-70. doi: 10.3899/jrheum.101136.
Epub 2011 Apr 1.
- Gonzalez-Juanatey C, Amigo-Diaz E, Miranda-Filloy JA, Testa A,
Revuelta J, Garcia-Porrua C, Martin J, Llorca J, Gonzalez-Gay MA. Lack of
echocardiographic and Doppler abnormalities in psoriatic arthritis patients
without clinically evident cardiovascular disease or classic atherosclerosis risk
factors. Semin Arthritis Rheum. 2006 Apr;35(5):333-9.
Disclosure of Interest: None Declared
SAT0279
USE OF A CALIBRATED SCORE CHART FOR
CARDIOVASCULAR RISK ASSESSMENT IN PATIENTS
WITH PSORIATIC ARTHRITIS, PSORIASIS ALONE
AND CONTROLS: RELATED VARIABLES AND
CORRELATION WITH CAROTID ULTRASOUND
C. Magro Checa1, J. Orgaz Molina2, J. L. Rosales Alexander3, J. Salvatierra3,
S. Arias Santiago3, E. Raya Alvarez3. 1Rheumatology, 2Dermatology, 3Hospital
Universitario San Cecilio, Granada, Spain
Background: A higher prevalence of cardiovascular (CV) risk factors has
been described in patients (pts) with psoriatic arthritis (PsA) and with moderate
to severe chronic plaque psoriasis (PS). Stratifying cardiovascular risk using
calibrated risk charts is central to decision-making on treatment to prevent CV
disease
Objectives: To assess and compare the CV risk in pts with PsA, pts with PS
alone and controls without clinically evident CV disease using a calibrated
SCORE. Compare these results with the presence of subclinical atherosclerosis
assessed by carotid ultrasound (CCA US)
Methods: We included 80 consecutive PsA patients who fulfilled the CASPAR
criteria, 80 patients with PS and 80 age and sex matched controls. Patients
with a previous CV event and diabetics were excluded. CV risk was calculated
using the cSCORE (high CV risk has been defined by a SCORE ≥ 5%), and
the presence of plaques was evaluated by B-doppler US. A one-way ANOVA
was performed to analyze the statistical difference between groups and
the concordance (Kappa Index) was calculated. Furthermore, multivariate
regression analysis was used to adjust for gender, age, body mass index,
classic CV risk factors, clinical and laboratory patterns, treatment, activity of
disease, and inflammatory markers (p<0,05 was considered significant)
Results: Based on the classic CV risk factors, the cSCORE in the PsA patients
was 1,70 ± 3,22% (mean ± standard deviation) and 7 pts (8,75%) were above
the threshold of high or very high CV risk (≥5%). In the groups of PS and
controls after applying the cSCORE the values were 1,45 ± 2,41 and 1,17
± 1,75. Therefore, 5 pts (6,25%) were classified above the threshold in both
groups. The CCA US revealed the presence of atherosclerotic plaques in
8 pts (10%) with PsA, 9 pts (11,25%) with PS and 2 (2,5%) in the group of
healthy controls. Statistical difference intergroups was not significant for the
cSCORE or the presence of plaques. Furthermore the cSCORE showed a bad
concordance (Kappa Index 0,51, 0,34 and 0,2, in the PsA, PS and controls
group respectively) with the presence of plaques. Multivariate regression
analysis showed that the only prognostic factors for predicting the cSCORE
in the three groups was the age (p< 0,05) and the variables associated with
subclinical atherosclerosis in the PsA pts were the age and the CRP (p< 0,05),
in PS, the age, gender and total cholesterol level (< 0,05) and in the group of
healthy controls the age. Clinical patterns of the PsA and PS, treatment and
activity of the disease were not associated with cSCORE.
Conclusions: In our study most of the patients with PsA and PS have low and
intermediate CV risk using the cSCORE. The correlation between cSCORE
and CCA US was poor. cSCORE may understimate the CV risk assessment
in patients with PsA and PS. Besides classic CV risk factors, some disease
characteristics might contribute to the expression of higher global CV risk in
these patients.
References: Gonzalez-Juanatey C et al. High prevalence of subclinical
atherosclerosis in psoriatic arthritis patients without clinically evident
cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum.
2007;57:1074-80.
Disclosure of Interest: None Declared
Downloaded from http://ard.bmj.com/ on October 25, 2017 - Published by group.bmj.com
SAT0277 Clinical Response in Early Psoriatic
Arthritis may be Predicted by Rapid
Reduction of a Semiquantitative Ultrasound
Synovitis Score
A. P. Nigg, A. M. Malchus, M. Gruenke, M. Witt, J. Prinz and H.
Schulze-Koops
Ann Rheum Dis 2013 72: A677
doi: 10.1136/annrheumdis-2013-eular.2002
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