Background A significant number of
rheumatoid arthritis (RA) patients can reach low disease activity
(LDA) by using TNF-inhibitors (TNF-i), but this therapy can cause
serious side-effects and is expensive. Therefore it could be
expedient to stop in case of LDA, especially if relapse can be
predicted. Ultrasonography of joints seems to be a predictor in
this respect in smaller studies.

The Dutch POET (Potential
Optimalisation of Expediency of TNF-i (TNF-inhibitor)) study, is a
multicenter randomized prospective cohort study investigating if in
patients with RA with LDA on TNF-i and conventional DMARD, the
TNF-i can be stopped. Patients were randomized to continue or stop
TNF-i. Part of this study is the POET-ultrasonography (US)
study.

Objectives To investigate whether US at the
time of stopping TNF-i in RA patients with LDA can predict future
flare.

Methods Data of patients who stopped TNF-i
in the POET study were used for this analysis. Participating
patients had RA according to ACR 1987 criteria, >6 months a
DAS28 <3.2 (LDA) and treatment with TNF-i > one year next to
a conventional DMARD, without dose change in the past six months.
Nineteen trained ultrasonographers performed US at baseline of the
study, using different US machines, of 20 joints (bilaterally: MCP
1-5 dorsal and volar, wrists and MTP 2-5 dorsal aspect). The joints
were graded on grayscale (GS; 0-3) and power doppler (PD; 0-3). US
signs of arthritis were defined as GS>1 and/or PD>0. Trial
visits were performed every 3 months and when flare was suspected.
Flare was defined as DAS28>3.2 and at least >0.6 increase
compared to the DAS28 at inclusion. Cox regression was performed to
compare TNF-i free LDA between patients with versus those without
US signs of arthritis (figure).

Results Nine months data were available for
248 patients. Twenty-one percent was lost to follow-up and censored
at last observation. Higher age, longer disease duration, anti-CCP
and IgM-RF positivity were all related to flare occurrence.
Patients with US signs of arthritis in one or more joints had a
greater risk of flare (HR 1.77; 95% CI of 1.16 to 2.70) and shorter
relapse-free period compared to patients without US signs of
arthritis (see figure).
The tableshows
patient- and US-characteristics at inclusion for patients without
flare within 9 months versus patients with flare.

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Conclusions On the group level, US can
predict flare in RA patients with LDA in whom TNF-i is
stopped.

Disclosure of Interest F. Lamers-Karnebeek
Grant/research support from: Abbvie, T. Jansen: None declared, P.
van Riel: None declared, J. Luime: None declared, J. Jacobs: None
declared