Background/Purpose:  Early seronegative rheumatoid arthritis (RA) is a separate entity. Less is known about its initial clinical presentation and outcome due to the difficulty in identification among patients with undifferentiated arthritis. The objective of this study was to determine predictors of good response to conventional DMARDs in seronegative RA patients in the ESPOIR cohort.

Methods:  Patients from the ESPOIR cohort with an early seronegative RA fulfilling the ACR-EULAR 2010 criteria were included. Primary endpoint was a good or moderate EULAR response evaluated at one year, after at least three months of treatment with conventional synthetic DMARDs (csDMARDs). Secondary objectives were to compare the early therapeutic response to methotrexate (MTX) and leflunomide (LEF) versus other csDMARDs (hydroxychloroquine, sulfasalazine), and to identify factors associated with functional disability (HAQ-DI > 0.5 at one year) and structural progression (modified total Sharp score > 1 and >5 points at one year). A Fisher exact test was used to compare categorical variables, and the Student or Mann Whitney tests for quantitative variables. Logistic regression analysis was used to determine independent predictors of outcome in multivariate analysis.

Results: 172 patients were analyzed: 81% women, mean age of 49.5+12.8 years. Mean DAS28 was 5.5+1.1 at baseline. 57% of patients were then treated with MTX. csDMARDs instituted early, i.e. within three months following the first joint swelling was significantly associated with EULAR good or moderate response at one year (OR = 2.41 95% CI [1.07- 5.42] p = 0.03) on univariate and multivariate logistic regression. Observed response rates were neither influenced by the type of first line csDMARDs (MTX vs other DMARDs), nor by other classical prognostic factors. Presence of erosions at baseline was significantly associated with progression of the Sharp score > 1 point (p = 0.03) and > 5 points (p = 0.03) at one year. HAQ ≥1 at inclusion and active smoking were significantly associated with an HAQ > 0.5 at one year.

Conclusion: Our results suggest that more than baseline clinical, biological or imaging features, it is the delay in initiation of csDMARD that greatly affects the outcome in patients with early seronegative RA.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictive-factors-of-good-response-to-conventional-dmards-in-patients-with-early-seronegative-rheumatoid-arthritis-data-from-the-espoir-cohort/