Ultrasound in anti-CCP+ at-risk individuals without clinical synovitis: development of a novel 6-joint protocol for feasible risk prediction
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All Authors
Matteo,Andrea Di
Lorenzis,Enrico De
Duquenne,Laurence
Nam,Jacqueline L.
Garcia-Montoya,Leticia
Harnden,Kate
Chowdhury,Rahaymin
Wakefield,Richard J.
Emery,Paul
Mankia,Kulveer
LTHT Author
Matteo, Andrea Di
Duquenne, Laurence
Nam, Jacqueline
Garcia-Montoya, Leticia
Harnden, Kate
Chowdhury, Rahaymin
Wakefield, Richard
Emery, Paul
Mankia, Kulveer
Duquenne, Laurence
Nam, Jacqueline
Garcia-Montoya, Leticia
Harnden, Kate
Chowdhury, Rahaymin
Wakefield, Richard
Emery, Paul
Mankia, Kulveer
LTHT Department
Rheumatology
NIHR Leeds Biomedical Research Centre
Drs Rotation
NIHR Leeds Biomedical Research Centre
Drs Rotation
Non Medic
Publication Date
2024
Item Type
Article
Language
Subject
Subject Headings
Abstract
Objectives To investigate, in anti-CCP antibody杙ositive individuals with musculoskeletal symptoms but no clinical synovitis (CCP+ at-risk), the additional value of US for the prediction of inflammatory arthritis. Furthermore, to define a concise US protocol for feasible risk prediction. Methods Demographic and clinical data were collected in 417 CCP+ at-risk (Leeds CCP cohort) with a baseline US scan assessing synovitis and bone erosions in 36 joints, and a follow-up duration ?24?months. Multivariable binary regression models for inflammatory arthritis development at 24?months evaluated routine clinical variables associated with inflammatory arthritis alone ('clinical' model) and combined with a 36-joint US scanning protocol ('clinical-US extended' model). A 'clinical-US short' model was also developed. Results At 24?months, 92/417 (22.1%) CCP+ at-risk developed inflammatory arthritis (median time 7?months, interquartile range 3�). The 'clinical-US extended' model performed better than the 'clinical' model area under the curve (AUC) 0.788 vs AUC 0.731, respectively, P ?<?0.001] with an odds ratio for inflammatory arthritis development of 3.18 (95% CI 1.80�63) for US synovitis and 2.54 (95% CI 1.21�37) for bone erosions. The 'clinical-US short' model, which retained the wrists, knees and MTP5 joints, performed better (AUC 0.782) than the 'clinical' model (P ?<?0.001) and similarly (difference in Akaike information criteria <2) to the 'clinical-US extended' model. Conclusions US provides valuable information for predicting progression to inflammatory arthritis in CCP+ individuals both alone and in addition to clinical variables. US synovitis was associated with a 3-fold increase risk of inflammatory arthritis development. A concise US protocol of six joints provides clinically feasible risk prediction in CCP+ at-risk.
Journal
Rheumatology