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Abstract Number: 1756

Comparable Long-Term Outcomes Among DAS28-ESR-based Remission Criteria and ACR/EULAR Definitions in Patients with Established Rheumatoid Arthritis

Felipe Julio Ramirez Garcia1, Jose Inciarte-Mundo2, Andrea Cuervo3, Raquel Celis4, Virginia Ruiz-Esquide4, Raul Castellanos-Moreira5, Andres Ponce4, Jose Gómez-Puerta6, Raimon Sanmartí6 and Juan Cañete7, 1Arthritis Unit, Rheumatology Dpt, Hospital Clinic, Barcelona, Spain, Barcelona, Catalonia, Spain, 2Hospital Universitari Clínic de Barcelona, Barcelona, 3Hospital Clínic, Barcelona, Spain, 4Hospital Clinic, Barcelona, Spain, 5Hospital Clinic of Barcelona, Barcelona, Spain, 6Hospital Universitari Clínic de Barcelona, Barcelona, Catalonia, Spain, 7Arthritis Unit, Rheumatology Dpt, Hospital Clinic, Barcelona, Spain and IDIBAPS, Barcelona, Spain

Meeting: ACR Convergence 2020

Keywords: Biomarkers, radiography, rheumatoid arthritis, Ultrasound

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Session Information

Date: Monday, November 9, 2020

Title: RA – Diagnosis, Manifestations, & Outcomes Poster IV: Lifespan of a Disease

Session Type: Poster Session D

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

Background/Purpose: To compare long-term clinical and radiographic outcomes among five sets of remission criteria [four clinical and one Ultrasound (US)-based] in a cohort of RA patients in a clinical care setting.

Methods: RA patients in remission (DAS28-ESR < 2.6) were selected. Hand US assessments were performed, and serum levels of inflammation/angiogenesis biomarkers were determined at baseline. Changes in baseline treatment and radiographic progression, defined as the variation in the modified Sharp van der Heijde score (mSHS) at 5 years, were analyzed.

To define remission, five different concepts were used, as follows: DAS28-ESR< 2.6, SDAI< 3.3, CDAI< 2.8, Boolean criteria and score Power Doppler (PD)=0.

Results: Eighty-seven patients with DAS28-ESR< 2.6 were included (table 1). One third fulfilled SDAI (33.3%), CDAI (31%) and Boolean (35.6%) remission criteria and 25.3% had no PD signal in the US evaluation.

26 patients (29.9%) changed the therapy, ranging from 13.6% (PD remission) to 33.3% (CDAI remission) (p=0.11) (Table 2).

Serum levels of ANG (p=0.015) and TNFa (p=0.025) were significantly lower in patients with Boolean remission, whereas IL-18 levels were significantly lower in those with PD remission (p=0.049). Patients without PD in the US assessment had significantly lower mSHS erosion progression (p=0.014) at 5 years (Figure).

Conclusion: Patients with established RA in DAS28-ESR remission had comparable clinical and radiographic outcomes than SDAI, CDAI and Boolean definitions in a clinical care setting.  US remission remained as the closest to structural damage abrogation.

Table 1. Baseline characteristics. *Data are expressed as mean (standard deviation) or as percentage; ACPA: anti-cyclic citrullinated peptide/protein antibody; bDMARD: biological Disease-Modifying antirheumatic drug; BMI: Body Mass Index; CDAI: Clinical Disease Activity Index; CRP: C-Reactive Protein; csDMARD: conventional synthetic Disease-Modifying antirheumatic drug; DAS: Disease Activity Score; ESR: erythrocyte sedimentation rate; GA: Global Assessment; mHAQ: Modified Health Assessment Questionnaire; PDN: prednisone; PDUS: Power Doppler Ultrasound; RF: Rheumatoid Factor; TJC: tender joint count; SDAI: Simplified Disease Activity Index; SJC: swollen joint count; SH: synovial hypertrophy.

Table 2. Rates of remission and baseline and clinical Follow-up at five years. CDAI: Clinical Disease Activity Index; DAS: Disease Activity Score; ESR: erythrocyte sedimentation rate; PD: Power Doppler; Rem: Remission; SDAI: Simplified Disease Activity Index.

Figure. mSHS Erosion Progression at five years. Data are expressed as mean of mSHS erosion subscore. CDAI: Clinical Disease Activity Index; DAS: Disease Activity Score; ESR: erythrocyte sedimentation rate; mdc: minimum detectable change; mSHS: modified Sharp van der Heijde Score; PD: Power Doppler; Rem: Remission; SDAI: Simplified Disease Activity Index;


Disclosure: F. Ramirez Garcia, None; J. Inciarte-Mundo, None; A. Cuervo, None; R. Celis, None; V. Ruiz-Esquide, None; R. Castellanos-Moreira, None; A. Ponce, None; J. Gómez-Puerta, Abbvie, 8, BMS, 8, GSK, 8, Lilly, 8, MSD, 8, Janssen, 8, Pfizer, 8, Roche, 5, 8; R. Sanmartí, None; J. Cañete, None.

To cite this abstract in AMA style:

Ramirez Garcia F, Inciarte-Mundo J, Cuervo A, Celis R, Ruiz-Esquide V, Castellanos-Moreira R, Ponce A, Gómez-Puerta J, Sanmartí R, Cañete J. Comparable Long-Term Outcomes Among DAS28-ESR-based Remission Criteria and ACR/EULAR Definitions in Patients with Established Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/comparable-long-term-outcomes-among-das28-esr-based-remission-criteria-and-acr-eular-definitions-in-patients-with-established-rheumatoid-arthritis/. Accessed .
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