Clinical Factors, Anti-Citrullinated Peptide Antibodies and MRI-Detected Subclinical Inflammation in Relation to Progression from Clinically Suspect Arthralgia to Arthritis

H.W. van Steenbergen¹, L. Mangnus², M. Reijnierse³, T. W. J. Huizinga¹ and A.H.M. van der Helm- van Mil², ¹Leiden University Medical Center, Leiden, Netherlands, ²Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ³Radiology, Leiden University Medical Center, Leiden, Netherlands

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: arthritis and inflammation, Early Rheumatoid Arthritis, MRI

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: Patients with Clinically Suspect Arthralgia (CSA) have, according to their rheumatologists, an increased risk on rheumatoid arthritis (RA), but their actual outcome is unexplored. This longitudinal study investigated (1) progression from CSA to clinically detectable arthritis and (2) associations of clinical factors, serological factors (among which anti-citrullinated peptide antibodies (ACPA)) and MRI-detected subclinical inflammation with arthritis development.

Methods: 150 CSA-patients were followed ≥6 months. At baseline, clinical and serological data were collected and unilateral 1.5T-MRI of MCP, wrist and MTP-joints was made. MRI-scoring was done according to the RA MRI scoring system. Subclinical MRI-inflammation was defined based on MRI-results of 193 symptom-free persons.

Results: During follow-up (median=75 weeks, interquartile range=40-106 weeks), 30 patients developed clinical arthritis; 87% did so <20 weeks after inclusion. In multivariable analyses, age, localisation of initial symptoms in small and large joints (compared to small joints only), CRP-level, ACPA-positivity and subclinical MRI-inflammation significantly associated with arthritis development; ACPA and MRI-inflammation were most strongly associated (hazard ratio (95% confidence interval) respectively, 6.43 (2.57-16.05) and 5.07 (1.77-14.50)). After 1-year follow-up, 31% of the patients with MRI-inflammation and 71% of the ACPA-positive patients with MRI-inflammation had progressed to arthritis. Forty-three percent of the patients that developed arthritis within 1-year were ACPA-negative; 78% of them had subclinical MRI-inflammation at baseline. When MRI-inflammation was absent arthritis development was infrequent (6% in all CSA-patients and 3% in ACPA-negative CSA-patients).

Conclusion: Subclinical MRI-inflammation precedes clinical arthritis with a few months. Subclinical MRI-inflammation is, independent of other factors such as ACPA, associated with arthritis development.

Disclosure: H. W. van Steenbergen, None; L. Mangnus, None; M. Reijnierse, None; T. W. J. Huizinga, None; A. H. M. van der Helm- van Mil, None.

To cite this abstract in AMA style:

van Steenbergen HW, Mangnus L, Reijnierse M, Huizinga TWJ, van der Helm- van Mil AHM. Clinical Factors, Anti-Citrullinated Peptide Antibodies and MRI-Detected Subclinical Inflammation in Relation to Progression from Clinically Suspect Arthralgia to Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/clinical-factors-anti-citrullinated-peptide-antibodies-and-mri-detected-subclinical-inflammation-in-relation-to-progression-from-clinically-suspect-arthralgia-to-arthritis/. Accessed .

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