POS0494 AN INVESTIGATION OF JOINT INFLAMMATION DEFINED BY COMPREHENSIVE ULTRASOUND ASSESSMENT AND PAIN SENSITISATION IN PATIENTS WITH ACTIVE RA

Background: Treat-to-target strategies have improved outcomes in patients with RA. Targets based on clinical assessments of tender (TJC) and swollen joints (SJC) were developed when most had active inflammatory disease. It is now recognised some pain sensitisation often termed fibromyalgia (FM), making assessment disease more complex. An indicator the difference between TJC SJC, an observation we described a pilot study (1). Objectives: To RA to describe relationships enhanced patient-reported outcome measures (PROMS) joint detected by comprehensive PDUS. Methods: 158 sequential DAS28ESR score >¬3.2 enrolled from GSTT Rheumatology after informed consent. They assessed rheumatologist for 66SJC, 68TJC, points & physician global. Recorded PROMS were: patient global, widespread index (WPI), symptom severity (somatic fatigue), FACIT fatigue, HAQ, EQ5D QoL, GAD7, PHQ9 PHQ15. All 44 US scored PD grey scale EULAR blind all data. Data recorded MedSciNet statistical analysis used STATA. Results: Patients meeting ACR 2010 criteria FM2(n=72) vs those that did not(n=86) similar demographics. SJC doppler scores higher non-FM group, whereas rheumatoid factor, DAS28 PROMs FM group. Analysis group differences using multinomial logistic regression subsequent regularised (lasso) regression, showed related 28TJC, FACIT-F PHQ15, 28SJC, logESR, lower Differences 28S/TJC, Physician Global FACIT-F. divided into four groups presence or absence at least one PDUS+ criteria; -FM-PD, -FM+PD, +FM-PD +FM+PD, data summarised Table 1. The -FM-PD -FM+PD negatively FACIT-F, Difference PHQ15 (-FM-PD). positively +FM+PD PHQ9, DAS28ESR. TABLE -FM -PD +PD +FM p-value Female 34 (79%) 33 (77%) 35 (83%) 22 (73%) 0.77 Total power 0.0 (0.0-1.0) 16.0 (10.0-25.0) (0.0-0.0) 9.0 (8.0-20.0) <0.001 gray 40.0(34.0-48.0) 57.5(45.0-82.0) 34.5(20.0-43.0) 60.0(46.0-84.0) Swollen JC 3.0 (1.0-5.0) 6.0 (3.0-9.0) 2.0 (0.0-5.0) 5.5 (2.0-10.5) Tender (3.0-12.0) 8.0 (4.0-11.0) 13.0 15.0 Tender-Swollen 4.0 (0.0-8.0) (0.0-4.0) (4.0-18.0) (2.5-13.5) ESR mm/hour 10.0 (8.0-16.0) 14.0 (10.0-30.0) 12.0 (7.0-23.0) 19.5 (11.5-42.5) 0.021 Pain VAS 50.0 (40.0-65.0) (30.0-60.0) 60.0 (47.5-77.5) 67.5 (55.0-80.0) Patient (30.0-70.0) 40.0 (40.0-80.0) 65.0 (50.0-80.0) 0.006 30.0 (20.0-50.0) (40.0-60.0) (20.0-40.0) (32.5-70.0) (ESR) 4.2 (3.7-4.9) 4.7 (4.1-5.2) (3.9-5.8) 5.6 (4.9-6.6) Conclusion: These detect disease, demonstrate inflammation defined as 1PDUS+ joint, may account activity slightly less than half unselected >3.2. This shows how frequently accounts symptoms signs We suggest addition central sensitisation, called FM, another identified here damage peripheral joints, likely due different mechanisms sensitisation. References: [1]Mian A et al, BMC Musculoskelet Disord. 2016;17: 404 [2]Wolfe F Arth Care Res 2010; 62:600 Disclosure Interests: Khaldoun Chaabo: None declared, Estee Chan: Toby Garrood: Zoe Rutter-Locher: Alexandra Vincent: James Galloway Speakers bureau: Dr has received speaker fees / honoraria Abbvie, BMS, Celgene, Chugai, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi UCB, Sam Norton: Bruce Kirkham Professor Pfizer,and UCB., Grant/research support from: research Novartis UCB. Pfizer