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Background Studies have previously demonstrated that ultrasound detected power Doppler (PD) activity (implying active synovial inflammation) may be present in a proportion of patients in clinical remission 1,2 and this can be used to accurately predict subsequent radiographic structural progression. 3 It may be hypothesised that such continued subclinical inflammation despite apparent remission as determined by traditional criteria may trigger a subsequent disease flare. Objectives Our study aimed to determine subclinical joint inflammation in patients with rheumatoid arthritis by power Doppler ultrasound in patients with rheumatoid arthritis at 12 months of adalimumab therapy. Methods Patients with RA who had received adalimumab therapy were enrolled. Patients underwent clinical, laboratory, and ultrasonographic assessment with power Doppler assessment of bilateral elbows (posterior recess), wrists (radio-carpal), second and third MCP joints (dorsal recess), MCP II and III, PIP II and III (dorsal recess), knee, ankle and MTPII and MTP V joint at 12th month. Results Power Doppler ultrasound was performed in 62 patients (87 females and 18 males; mean age: 57.09±9.96 years). The mean baseline DAS28 were 8.13±9.52. Baseline PD score (mean ±SD) were 0.852 ±1.051 and after 12 month of adalimumab therapy, the PD score decreased to 0.23±0.42. Ultrasound was performed 12th month at various parts, with the mean GS score: most prominent at right wrist (.810±.924) and left wrist (.774±.909) (Table).Logistical regression confirmed diabetes, positive anti-CCP, high DAS28 had more sonographic inflammation, while hypertension and positive rheumatoid factor (RF) had less sonographic inflammation. MTX, glucocorticoid and cyclosporin therapy had increased inflammation. Conclusions Our data confirm the evidence that even after 1 year of biological therapy, there were still persistent subclinical synovitis, more severe at wrist joints. Baseline high DAS28 and high PD activity had more prone to residual inflammation. So we recommended serial ultrasound follow up of PD ultrasound in patients with rheumatoid arthritis after adalimumab therapy. References Saleem B, et al. Arthritis Rheum. 2009;60(7):1915–22. Brown AK, et al. Arthritis Rheum. 2006;54(12):3761–73. Brown AK, et al. Arthritis Rheum. 2008;58(10):2958–67. Disclosure of Interest None declared

Background In previous studies, the patients achieved greater disease control by adalimumab at 24 weeks, this response was maintained over the next 24 weeks 1 , however, we could not found the characteristic in image to confirm the clinical presentations. Objectives This study aimed to validate the use of power Doppler ultrasonography (PDUS) for evaluating synovial vascularity and synovial hypertrophy for synovitis in patients with rheumatoid arthritis (RA) treated with adalimumab. Methods The synovial disease activity and vascularity of RA on both wrists (radio-carpal joint) were assessed using GS and PDUS to derive the composite US scores based on abnormal counts and severity. The relationship between each measure was determined. Results The 71 patients who received adalimumab therapy had significantly decreased DAS28, ESR, and CRP. After one month, PD score decreased and then remained low for 12 months. Synovial hypertrophy did not change until 3–6 months after, when it started to improve ( p =0.017). By multivariate analysis, sex, age, BMI, and DAS28 did not lead to any difference between synovial hypertrophy and PDUS changes ( p =0.498). Conclusions Composite US markers of synovial hypertrophy correlate significantly to the DAS28 score and ESR/CRP in adult RA. The time needed for synovial hypertrophy to decrease may be up to 3–6 months after adalimumab therapy. Using ultrasound Doppler measurements predict success of treatment with anti-TNF-alpha has been a trend in monitoring biological therapy in patients with RA References Keystone EC, et al. Arthritis and rheumatism. May 2004;50(5):1400–1411. Disclosure of Interest None declared

Background Studies using ultrasound (US) showed that a significant proportion of patients thought to be in clinical remission actually exhibited different grades of synovitis, and a subgroup of these patients suffered from flares and/or joint damage during follow-up 1 . Objectives Evaluate joint inflammation by ultrasound in patients with different stages of rheumatoid arthritis as the primary endpoint measure. Methods Gray scale and power Doppler ultrasound were performed on the dorsal radio-scaphoid, dorsal radio-lunae, ulnar-triquetrium, and palmar radio-lunate joints of both wrists. The presence of synovitis, comorbidities, and use of disease modifying anti-rheumatic drugs were recorded. Patient with a bilateral wrist score sum (GSUS + PDUS) equal or greater than 4 was considered to have sonographic inflammation. A logistical regression model was used to identify factors associated with inflammation. Results There were 1248 patients (1010 females, 238 males; mean age: 59.61 ± 12.19 years). Synovitis was most common at the dorsal radio-lunate joint. Patients with high disease activity (DAS28 >5.1) had more sonographic inflammation than those with moderate or low disease activity. Most patients (57.4%) in complete remission (DAS28 Conclusions There was sonographic evidence of synovitis in most patients who were in complete remission. Regular monitoring of rheumatoid arthritis patients with ultrasound and DAS28 may help prevent disease flare-ups and joint destruction. References Brown AK, et al. Arthritis and Rheumatism 2006;54:3761–3773. Disclosure of Interest None declared