Clinical and Ultrasonographic Inflammation in DMARD-Naïve Early Rheumatoid Arthritis (RA) - Impact of the 2010 ACR/EULAR Classification Criteria Versus the 1987 ACR Classification Criteria

Maria K. Jonsson^1,2,3, Siri Lillegraven², Lena B. Nordberg², Anna-Birgitte Aga², Hilde B. Hammer⁴, Inge C Olsen², Bjørg-Tilde Fevang^1,5, Tore K. Kvien², Espen A. Haavardsholm² and the ARCTIC Study Group, ¹Dept. of Rheumatology, Haukeland University Hospital, Bergen, Norway, ²Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ³Dept. of Clinical Science, University of Bergen, Bergen, Norway, ⁴Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ⁵Department of Clinical Science, University of Bergen, Bergen, Norway

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: classification criteria and inflammation, Early Rheumatoid Arthritis

Session Information

Date: Sunday, November 8, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: ACR and EULAR published new classification criteria for RA in 2010, aiming for early identification of patients at risk of developing persistent and erosive arthritis. Ultrasonographic examination (US) yields information on inflammation in joints and tendons in RA. Our aim was to investigate whether US inflammation, as well as clinical measures of inflammation, were different in disease modifying anti-rheumatic drug (DMARD) naïve patients fulfilling only the 2010 ACR/EULAR criteria compared to patients fulfilling both the 2010 ACR/EULAR and the 1987 ACR classification criteria for RA.

Methods: RA patients (n=235) who fulfilled the 2010 ACR/EULAR classification criteria were recruited between 2010 and 2013. All patients had symptom duration from first swollen joint < 2 years and were DMARD-naïve with indication for DMARD treatment. US inflammation was evaluated as grey-scale (GS) synovitis and vascularization assessed by power Doppler (PD) in 32 joints by a standardized protocol, with range 0-3 for each joint (1). Clinical inflammation was assessed by 44 swollen joint count, Ritchie Articular Index (RAI), erythrocyte sedimentation rate (ESR) and the Disease Activity Score (DAS). Disease characteristics were compared between the groups using chi-square test, t-test and Mann-Whitney U-test as appropriate.

Results: The 235 patients included had mean (SD) age 51.4 (13.7) years, median disease duration [25, 75 percentiles] 5.7 [2.8, 10.2] months, 62.1% were female, and 81.3% were positive for anti-citrullinated protein antibodies (ACPA). Inflammation assessed by DAS, ESR and US was significantly higher in patients fulfilling both the 1987 and 2010 criteria, compared to patients only fulfilling the 2010 criteria (Table). There was no significant discrepancy in gender distribution, age, disease duration or the proportion of ACPA-positive individuals when comparing the two groups.

Conclusion: Patients with early RA fulfilling only the new 2010 ACR/EULAR criteria had less severe disease, both clinically, biochemically and assessed by ultrasonography, compared to patients fulfilling both the 1987 ACR criteria and the 2010 ACR/EULAR criteria. This may reflect the change in treatment strategies that has occurred over time, with earlier initiation of DMARD treatment. Long-term outcomes of function and morbidity are needed to understand the potential shift in the RA construct caused by the implementation of the new classification criteria.

Table: Disease characteristics in patients fulfilling only the 2010 ACR/EULAR classification criteria versus both the 1987 ACR and the 2010 ACR/EULAR classification criteria.

	Patients fulfilling only the 2010 ACR/EULAR criteria n=77	Patients fulfilling both the 2010 ACR/EULAR criteria and the 1987 ACR criteria n=158	p–value
Female % (n)	62.3 (48)	62.0 (98)	0.96
Age, years¹	51.5 (12.8)	51.4 (14.2)	0.99
ACPA-positive % (n)	79.2 (61)	82.3 (130)	0.57
Disease duration³, months²	6.1 [2.9, 9.9]	5.5 [2.8, 10.2]	0.82
DAS-score¹	2.9 (1.1)	3.7 (1.0)	<0.001
Swollen joint count²	5 [3, 10]	11 [7, 15]	<0.001
ESR, mm/hr²	16 [10, 26]	22 [13, 36]	0.002
Ritchie Articular index²	5 [3, 8]	8 [4, 13]	<0.001
Total US score GS²	12 [7, 22]	21 [13, 30]	<0.001
Total US score PD²	4 [2, 9]	8 [4, 15]	<0.001
¹Mean (SD). ²Median [25, 75 percentiles]. ³Disease duration from first swollen joint.

Disclosure: M. K. Jonsson, None; S. Lillegraven, None; L. B. Nordberg, None; A. B. Aga, None; H. B. Hammer, None; I. C. Olsen, None; B. T. Fevang, None; T. K. Kvien, None; E. A. Haavardsholm, AbbVie, 2,Pfizer Inc, 2,MSD, 2,Roche Pharmaceuticals, 2,UCB, 2.

To cite this abstract in AMA style:

Jonsson MK, Lillegraven S, Nordberg LB, Aga AB, Hammer HB, Olsen IC, Fevang BT, Kvien TK, Haavardsholm EA. Clinical and Ultrasonographic Inflammation in DMARD-Naïve Early Rheumatoid Arthritis (RA) – Impact of the 2010 ACR/EULAR Classification Criteria Versus the 1987 ACR Classification Criteria [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/clinical-and-ultrasonographic-inflammation-in-dmard-naive-early-rheumatoid-arthritis-ra-impact-of-the-2010-acreular-classification-criteria-versus-the-1987-acr-classification-criteria/. Accessed .

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