Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Fatigue in rheumatoid arthritis (RA) is common and highly debilitating. Emerging evidence suggests that seronegative RA patients differ from their seropositive peers in genetic susceptibility, immunology, and clinical characteristics. One pathway shown to have increased activity in seronegative RA patients is the IL-6/STAT3 signaling pathway. We hypothesized that selected symptoms (fatigue, pain, sleep) and impacts (physical function and social participation) would be worse in CCP negative participants.
Methods: Data are from a prospective cohort study of patients receiving guideline-based RA care in an academic clinic. Baseline visits conducted from 10/12 to 1/14 were included in this cross sectional analysis. Patients meeting ACR criteria for RA and for whom information on CCP status was available were included in this study. Selected symptoms and impacts were assessed using The NIH Patient Reported Outcome Measurement Information System (PROMIS) computer adaptive tests and compared by CCP status with t-tests. Linear regression models were used to evaluate the impact of CCP status on fatigue after adjusting for potential confounders.
Results: The 165 participants were 82% female with mean age of 56 (SD 13.1). CCP negative and positive participants differed only by disease duration, with CCP negative patients having shorter duration (Table 1). Exploratory analysis evaluating average T-scores of eight PROMIS domains and pain VAS showed statistically significantly higher levels of fatigue in CCP negative patients as compared to their CCP positive counterparts (table 1). Similar trends with higher anxiety levels and pain interference, and impairments in physical function and participation were seen in the CCP negative group (p<.10). Associations between greater fatigue and CCP negativity persisted after adjustment for sociodemographic and other characteristics (table 2).
Conclusion: In RA, CCP negativity is a robust independent predictor of greater fatigue and may be associated with greater impairments in disability and participation. These results suggest that some symptoms are associated with autoantibody status and may indicate differential activity of IL-6/STAT3 signaling.
Table 1. Participant characteristics by CCP status (n = 165) .
|
Characteristic |
CCP- n = 54 |
CCP+ n= 111 |
Sig |
|
Age
|
58.2 (14.6) |
55.1 (12.2) |
0.16 |
|
Sex- n (%) |
Male- 7 (13%) |
Male- 22 (20%) |
0.28 |
|
Race- n (%)
|
White- 46 (85%) Black- 6 (11%) Other- 2 (4%) |
White- 89 (80%) Black- 15 (14%) Other- 6 (54%) |
0.78 |
|
Disease duration (yrs) |
9.3 (6.9) |
13.0 (10.6) |
0.02 |
|
Swollen joints (28) |
2.3 (3.7) |
2.0 (2.9) |
0.65 |
|
Tender joints (28) |
1.6 (3.2) |
1.1 (2.4) |
0.20 |
|
MD Global |
14.4 (16.2) |
12.5 (13.7) |
0.42 |
|
Patient Global |
29.0 (26.6) |
28.7 (27.5) |
0.94 |
|
Clinical Disease Activity Index (CDAI) |
8.6 (8.0) |
6.9 (7.2) |
0.18 |
|
Fatigue |
56.0 (9.2) |
52.4 (10.1) |
0.03
|
|
Pain VAS |
31.2 (27.7) |
29.7 (28.9) |
0.76 |
|
Pain Interference |
55.3 (8.8) |
52.8 (9.7) |
0.06 |
|
Sleep Disturbance |
52.5 (9.7) |
50.8 (9.4) |
0.30 |
|
Sleep Impairment |
51.7 (8.9) |
50.8 (9.6) |
0.58 |
|
Depression |
49.8 (8.9) |
48.5 (8.4) |
0.37 |
|
Anxiety |
51.9 (8.5) |
50.0 (7.6) |
0.08 |
|
Physical Function |
41.5 (9.1) |
44.2 (8.9) |
0.07 |
|
Ability to Participate in Social Roles |
48.4 (8.8) |
51.3 (8.9) |
0.05 |
|
Values are the mean (SD) unless otherwise indicated |
|||
Table 2. Relationship between CCP status and outcome of PROMIS fatigue (Crude and adjusted coefficients)
|
|
Crude (95% CI) |
Adjusted (95% CI) |
|
CCP- |
3.66 (0.45, 6.87) |
3.53 (0.35, 6.72) |
|
Age |
0.0002 (-0.12, 0.12) |
-0.03 (-0.15, 0.08) |
|
Female sex |
-0.63 (-4.50, 3.24) |
-1.21 (-5.23, 2.80) |
|
Minority vs. white |
3.75 (-.017, 7.68) |
3.54 (-0.02, 7.48) |
|
Swollen joints
|
0.74 (0.29, 1.20) |
0.74 (0.27, 1.23) |
To cite this abstract in AMA style:
Cappelli L, Bartlett SJ, Jones M, Bingham C. CCP Antibody Negativity Is Associated with Higher Fatigue in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/ccp-antibody-negativity-is-associated-with-higher-fatigue-in-rheumatoid-arthritis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/ccp-antibody-negativity-is-associated-with-higher-fatigue-in-rheumatoid-arthritis/