THU0162 Residual synovitis in ankles and feet detected by ultrasonography in patients with rheumatoid arthritis

Background Twenty eight joints that are usually evaluated for disease activity score of rheumatoid arthritis (RA) do not include ankles and metatarsophalangeal joints. Although foot synovitis of patients in remission is clinically important in that it associates to relapse and worse physical function,1 composite markers without an assessment of foot have demonstrated poor performance in detecting foot synovitis.2 Objectives The aim of this study was to investigate the frequency and impact of residual synovitis in ankles and feet in patients with RA. Methods Patients with RA who underwent both physical examination and ultrasonography (US) on 44 joints including hands, fingers, ankles, and metatarsophalangeal joints between April 2016 and January 2018 in Keio University Hospital were enrolled. We compared patients with swollen joints of feet and ankles and those without, and then analysed those who did not have swollen joints by physical examination but were detected to have synovitis by US. Results Sixty one patients were enrolled in the study. The mean age was 58.5 years old, the disease duration was 7.1 years, and 85% were female. Among them, 21 patients had joint swelling in feet and ankles and 40 patients did not by physical examination. The patients in the former group showed significantly higher disease activity (DAS28 4.0 vs 2.4, p Conclusions The residual synovitis in ankles and feet did not reflect in remission criteria by DAS28 but did by Boolean criteria. It caused a discordance in global assessments between patient and estimator. References [1] Wechalekar MD, Lester S, Hill CL, Lee A, Rischmueller M, Smith MD, Walker JG, Proudman SM. Active Foot Synovitis in Patients With Rheumatoid Arthritis: Unstable Remission Status, Radiographic Progression, and Worse Functional Outcomes in Patients With Foot Synovitis in Apparent Remission. Arthritis Care Res (Hoboken)2016;68(11):1616–1623. [2] Wechalekar MD1, Lester S, Proudman SM, Cleland LG, Whittle SL, Rischmueller M, Hill CL. Active foot synovitis in patients with rheumatoid arthritis: applying clinical criteria for disease activity and remission may result in underestimation of foot joint involvement. Arthritis Rheum2012;64(5):1316–22. Disclosure of Interest None declared