title: Exploring a new ultrasound score as a clinical predictive tool in patients with rheumatoid arthritis starting abatacept: results from the APPRAISE study.
abstract: OBJECTIVE
  To explore whether changes in a composite (power Doppler/greyscale ultrasound (PDUS)) synovitis score, developed by the OMERACT-EULAR-Ultrasound Task Force, predict disease activity outcomes in rheumatoid arthritis (RA).
  
  
  METHODS
  Patients with RA who were methotrexate inadequate responders starting abatacept were evaluated. Individual joint PDUS scores were combined in the Global OMERACT-EULAR Synovitis Score (GLOESS) for metacarpophalangeal joints (MCPs) 2-5, all joints (22 paired) and a reduced (9 paired) joint set. The predictive value of changes in GLOESS at week 1-16 evaluations for clinical status and response (Disease Activity Score (DAS)28 (C reactive protein, CRP) <2.6; DAS28(CRP) ≤3.2; DAS28(CRP) ≥1.2 improvement) up to week 24, and correlations between DAS28 and GLOESS were assessed.
  
  
  RESULTS
  Eighty-nine patients completed the 24-week treatment period. Changes in GLOESS (MCPs 2-5) from weeks 1 to 16 were unable to predict DAS28 outcomes up to week 24. However, significant improvements in GLOESS (MCPs 2-5) were observed at week 12 in patients with DAS28 ≥1.2 improvement at week 24 versus those who did not achieve that clinical response. In patients achieving DAS28 ≥1.2 improvement or DAS28 ≤3.2 at week 24, changes in GLOESS (22 and 9 paired joint sets) were greater in patients who already achieved DAS28 ≥1.2 at week 12 than in those who did not. No significant correlations were found between changes in DAS28 and GLOESS definitions at any time point.
  
  
  CONCLUSIONS
  PDUS was not correlated with clinical status or response as measured by DAS28-derived criteria, and PDUS changes were not predictive of clinical outcome. The discrepancies require further exploration.
  
  
  BACKGROUND
  NCT00767325; Results.
authors.affiliation: APHP , Hôpital Ambroise Paré, Service de Rhumatologie, 92100 Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, Université Paris Ouest-Versailles St.-Quentin , 78180 Saint Quentin en Yvelines , France.
authors.forename: Maria-Antonietta
authors.initials: MA
authors.lastname: D'Agostino
authors.affiliation: Departments of Epidemiology & Biostatistics , The Amsterdam Rheumatology & Immunology Center, VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Boers
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit (LMBRU), University of Leeds , Leeds , UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wakefield
authors.affiliation: Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.
authors.forename: Hilde
authors.initials: H
authors.lastname: Berner Hammer
authors.affiliation: Rheumatology Department & CIC-CRB-1404, Inserm U905 , Rouen University Hospital, Rouen University , Rouen , France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Vittecoq
authors.affiliation: Department of Medicine, Surgery and Neurosciences, Rheumatology Section , University of Siena , Siena , Italy.
authors.forename: Georgios
authors.initials: G
authors.lastname: Filippou
authors.affiliation: 3rd Rheumatology Department , National Institute of Rheumatology and Physiotherapy , Budapest , Hungary.
authors.forename: Peter
authors.initials: P
authors.lastname: Balint
authors.affiliation: Rheumatology Department , Instituto Poal , Barcelona , Spain.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Möller
authors.affiliation: Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche , Sapienza Università di Roma , Roma , Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.affiliation: Department of Rheumatology , Hospital GU Gregorio Marañón , Madrid , Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.affiliation: Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Østergaard
authors.affiliation: Medical Affairs , Bristol-Myers Squibb , Rueil-Malmaison , France.
authors.forename: Corine
authors.initials: C
authors.lastname: Gaillez
authors.affiliation: Medical Affairs , Bristol-Myers Squibb , Rueil-Malmaison , France.
authors.forename: Manuela
authors.initials: M
authors.lastname: Le Bars
keywords: DMARDs (biologic); Disease Activity; Rheumatoid Arthritis; Ultrasonography