Ab0231 Proliferative Synovitis: An Ultrasound Pattern Associated With Erosive Disease and Chronic Use of Glucocorticoids in Patients With Arthritis. A Cross-Sectional and Multicenter Study

Background: We have previously described the association of the ultrasound (US) pattern called proliferative synovitis (Synovial hypertrophy≥2+Power Doppler) with erosive disease, Anti-citrullinated antibodies (ACPA) and long-term need of therapy modifications in patients with Rheumatoid Arthritis (RA).[1] Objectives: The aim of this study is to validate the association of US proliferative synovitis with both erosive disease and use of therapy in patients with chronic arthritis beyond RA. Methods: Cross-sectional, multicenter study. Clinical, epidemiological, and ultrasound variables were collected from patients with chronic arthritis and active hand inflammation in the physical assessment. Microcrystalline arthritis and recent onset arthritis (<6 months) were excluded. Synovial hypertrophy and Power Doppler signal were evaluated in carpal, metacarpophalangeal, carpal extensor tendons, and hand flexor tendons. US proliferative synovitis was defined as Synovial hypertrophy≥2+Power Doppler (Figure 1). Results: Two hundred and twenty-three patients from 8 centers were included: 65.9% were women (mean age of 58.1 years, SD±14.5 and mean disease duration of 113 months, SD±134.9). One-hundred and seven patients (47.9%) had RA (31.4% Rheumatoid Factor and/or ACPA positive) and 88 patients (39.5%) had psoriatic arthritis (PsA). The other 28 patients had elderly-onset arthritis (9 patients, 4%), peripheral SpA (5 patients, 2.2%), mixed connective tissue disease (4 patients, 1.8%), lupus (1 patient, 0.4%) and undifferentiated arthritis (9 patients, 4%). Overall, 104 patients (46.6%) had erosive disease, and 83 (37.2%) were on targeted therapies. Ninety-six patients (43%) were receiving oral glucocorticoids(≤5mg of prednisone). At the time of the US assessment, all patients had active disease (mean SDAI 27.9, SD±25.1, and mean DAPSA 22.1, SD±11.6). Disease activity (p=0.05) and US score (p=0.037) were significantly higher, and the disease duration longer (p=0.013) in RA patients. The use of conventional DMARDs (p=0.039) and glucocorticoids (p=0.0001) was also more prevalent in RA patients, but no significant differences were found in targeted therapies. The percentage of patients with erosive disease showed a numerical increase in RA compared to non-RA patients (52.6% versus 38.8%, p=0.055). One hundred and fourteen patients (51.1%) met criteria for US proliferative synovitis, 102 patients (45.7%) had tendon involvement and 27 patients (12.1%) had only tendon inflammation without synovial joint component. US proliferative synovitis was significantly more frequent in RA versus other diagnosis (60% versus 39.1%, p<0.003) and in seropositive (73.6%) versus seronegative RA (52.9%, p<0.001). Exclusive tendon inflammation (16.1%, p=0.033) and extensor paratendonitis (29.1%, p=0.035) were both more frequent in PsA (Table 1). Among patients with US proliferative synovitis, 76% exhibited erosive disease, whereas only 22.2% without US proliferative synovitis showed erosive disease (p=0.0001). In the multivariable analysis, after adjusting for age, sex, diagnosis, autoantibodies (RF and ACPA), disease activity, and treatment, the presence of erosive disease [OR 8.5 (4.2-17.2), p=0.0001] and use of glucocorticoids [OR 1.9 (1.0-3.9), p=0.046] were independently associated with the presence of US proliferative synovitis. Conclusion: In a cohort of patients with active hand arthritis, the presence of US proliferative synovitis was associated with erosive disease and chronic oral glucocorticoids intake. These results are consistent with previous findings[1]. REFERENCES: [1] Ramírez J, Azuaga-Piñango AB, Frade-Sosa B, et al. Proliferative synovitis, an ultrasound pattern associated with ACPA-positive patients and erosive disease in rheumatoid arthritis. Clin Exp Rheumatol. 2022 May;40(5):960-966. Acknowledgements: To patients for their kind participation. Disclosure of Interests: None declared.