Background/Purpose: RA is characterized by the production of autoantibodies including anti-citrullinated protein antibodies (ACPAs).¹ ACPAs are considered a prognostic indicator for more severe RA and more rapid disease progression.^2,3 Little is known regarding the incidence of erosions overall in a contemporary cohort of patients with access to biologics or the association with ACPA status. This analysis aimed to characterize the incidence of erosive disease and its association with ACPA serological status in patients with RA.

Methods: We identified patients aged ≥18 years with RA disease duration ≤2 years who were enrolled in the Corrona Registry (October 2001 to June 2016) with ACPA status available at or before their enrollment visit and no evidence of erosions on their first visit at which radiographic information was reported. To assess incidence of erosions, we followed patients until their first radiograph showed evidence of erosions or their last follow-up visit, whichever came first. The primary outcome was the incidence of erosions (calculated as the total number of first erosions divided by the total radiographic follow-up time), overall and by ACPA status (negative anti-cyclic citrullinated peptide [CCP] <20 vs positive anti-CCP ≥20), unadjusted and adjusted (for age and baseline disease activity using the CDAI). Cox proportional hazards modeling was used to assess the hazard ratio (HR) (with 95% CIs) of erosive disease.

Results: In total, 693 patients (452 ACPA positive and 241 ACPA negative) met the inclusion criteria. Most were women (70.6%), middle-aged (mean [SD] 55 [13.3] years), with moderate disease activity based on the CDAI (13.9 [13.0]). Prior use of ≥1 biologic/targeted synthetic DMARD had occurred in 29.3% of patients. In total, 187 first erosions over 1344.27 person-years of radiographic follow-up time were recorded with an incidence rate of 13.9 erosions/100 person-years of follow-up. The incidence of erosions among ACPA-positive patients was 14.8/100 person-years vs 12.2/100 person-years in those who were ACPA negative (unadjusted HR 1.21; 95% CI 0.88, 1.67; p=0.23; Table). In adjusted analyses, ACPA status was associated with the incidence of erosions (HR 1.30; 95% CI 0.94, 1.80; p=0.11), although the estimate included unity (Table).

Conclusion:

In this contemporary cohort of patients with early RA, incident erosions were common. Our findings suggest further exploration of the association of ACPAs and the incidence of erosions is needed, and whether medications including biologic/targeted synthetic DMARDs influence the relationship.

1. Scott DL, et al. Lancet 2010;376:1094–108.

2. Hecht C, et al. Ann Rheum Dis 2015;74:2151–6.

3. Aletaha D, et al. Arthritis Res Ther 2015;17:229.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-between-anti-citrullinated-protein-antibody-status-and-the-incidence-of-erosive-disease-in-patients-with-ra/