Session Type: Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Autoantibody positivity, erosions, activity level, and functional capacity were classically defined as poor prognosis. Paradoxically, many of them also predict a good response to treatment. Objective: To estimate the proportion of patients achieving remission and low activity by CDAI and SDAI per year in a cohort of patients with RA. To assess the impact of basal ACPA titers and total cholesterol level on response to treatment.
Methods: An observational study, where patients older than 18 who entered the Reumacheck program were included, in the first visit it was carried out: laboratory (including ACPA and total cholesterol: CT), Rx, ultrasound, and interview where were collected sociodemographic data (age, sex, schooling, occupation, toxic habits), clinical data (time of evolution, comorbidities, family history) and CDAI, SDAI, HAQ; each evaluator did not know the data from the other studies and evaluations, ACPA levels were measured in titles and divided into quartiles (Q1: 0-5, Q2: 5-50, Q3:50 -200, Q4: > 200). Those who were diagnosed with RA one year underwent a new control (FR and ACPA) where the same laboratory, clinical and treatment data were collected, and CDAI and SDAI remission and low activity (LDA) were calculated. Statistical analysis: descriptive statistics, Chi2 test and Fisher’s exact test were performed. T-test of student and Mann Whitney. Multiple logistic regression. ROC curve analysis to estimate cutoff values for cholesterol.
Results: Of the 183 patients diagnosed with RA between 2018-19, 83 performed a new check-up per year. The baseline characteristics are in Table 1. They achieved CDAI – SDAI remission at one year, CDAI-SDAI LDA (%): 21, 22.4, 55.3, 55 respectively. Reaching CDAI LDA (≤ 10) was associated at baseline to: ACPA (yes-no) 64.4% p 0.05 RR 2.5 (1.02-6.4), ACPA quartile 3-4 76.5% p 0.016 RR 3.3 (1.2-11.5), ACPA title 79.5 vs. 3.95 p 0.04, initiation of anti TNF 66% p 0.04 RR 2.6 (1.3-6 ), CT levels 185 vs 207 p 0.04, HAQ 0.5 vs 0.8 p 0.047 and swollen joints 1 (0-3) vs 2 (0-6) p 0.05. CDAI remission (≤ 2.8) was associated only with lower baseline total cholesterol levels: 170 (38) vs. 202 (47) p 0.025.
Reaching SDAI LDA (≤ 11) was associated at baseline to: ACPA (yes-no) 69% p 0.05 RR 2.5 (1.01-6.4), ACPA quartile 3-4 76% p 0.016 RR 3 , 3 (1,2-11), ACPA titer 80 vs 3.45 p 0.047, initiation of anti TNF 66.7% p 0.04 RR 2.6 (1.2-6), levels CT 184 vs 206 p 0.04, HAQ 0.5 vs 0.78 p 0.047 and swollen joints 1 (0-3) vs 2 (0-6) p 0.05. SDAI remission (≤ 3.3) was associated only with lower baseline total cholesterol levels: 168 (36) vs. 203 (47) p 0.025. Two logistic regression models were made, where the predictor variables, sex, age, dyslipidemia, use of statins and treatment were included: both for CDAI and SDAI LDA was independently associated with ACPA quartile 3-4 p 0.02 expB 3 and high cholesterol p 0.016 expB 0.21. In the ROC curve analysis, the best cut-off value was estimated for the baseline CT level predicted by CDAI LDA: AUC 0.67 (0.54-0.8): value 180 (S: 70% E: 50%) for both.
Conclusion: Patients with RA at one-year follow-up reached CDAI – SDAI remission, CDAI-SDAI LDA (%): 21, 22.4, 55.3, 55 respectively. High ACPA titers and low cholesterol levels were associated with achieving remission and LDA by these methods.
To cite this abstract in AMA style:Garcia Salinas R, Ruta A, Ruta S, Sanchez Prado E, Torres Chichande J, Magri S. ACPA and Cholesterol Titers as Predictors of Good Clinical Response at One Year in an Argentine Cohort [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/acpa-and-cholesterol-titers-as-predictors-of-good-clinical-response-at-one-year-in-an-argentine-cohort/. Accessed November 26, 2020.
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