ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1463

Do Anti-Citrullinated Protein Antibodies and Anti-Sjögren’s-Syndrome-Related Antigen a Double Positive Patients with Secondary Sjögren’s Syndrome and RA Have Higher Joint Disease Activity?

Evo Alemao1, Yogesh Saini2, Ying Bao1, Aarti Rao2, Christine K Iannaccone3, Michelle Frits3, Michael E Weinblatt3 and Nancy A. Shadick3, 1Bristol-Myers Squibb, Princeton, NJ, 2Mu Sigma, Bangalore, India, 3Brigham and Women's Hospital, Boston, MA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: , , ,

Session Information

Date: Monday, October 22, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster II: Diagnosis and Prognosis

Session Type: ACR Poster Session B

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

Background/Purpose: Secondary Sjögren’s syndrome (sSS) is considered an extra-articular manifestation of RA and is an autoantibody-mediated condition similar to RA. Thus, patients (pts) with sSS could be anti-citrullinated protein antibodies (ACPA) and anti-Ro/Sjögren’s-syndrome-related antigen A (SSA) autoantibody double positive (double+). There are limited data on the impact of double positivity on RA disease burden. The objective of this analysis was to compare pts with sSS with and without double positivity.

Methods: Data from adult pts with RA enrolled in a longitudinal sequential RA registry were analyzed. Pts in the registry were evaluated annually by a rheumatologist for disease activity and treatment, and semi-annually on multiple clinical patient-reported outcomes (PROs) and resource utilization parameters. Pts with sSS were identified with a clinician’s diagnosis or based on meeting the 2016 ACR/EULAR classification of primary Sjögren’s syndrome. Pts with sSS were divided into two mutually exclusive groups: pts with and without double positivity (the latter including single positive or double negative pts). The two cohorts were compared using descriptive statistics to summarize baseline differences in demographics, disease activity measures, serostatus and treatments. A Kruskal–Wallis test for continuous variables and a chi-square test for categorical variables were performed with a significance level of 0.05. Mean changes from baseline to 12 months in disease activity measures and PROs were assessed for pts with available data at baseline and follow-up.

Results: A total of 415 pts were identified as having sSS associated with RA, with 80 (19.3%) and 86 (20.7%) pts in the cohorts with and without double positivity, respectively. The double+ pts with sSS were diagnosed with RA at a younger age, had longer duration since onset of RA symptoms and a higher number of swollen joints compared with pts with sSS without double positivity (Table 1). In addition, the mean changes in disease activity were lower in pts with versus without double positivity, though these were not statistically significant, potentially due to the limited sample size (Table 2).

Conclusion: Pts with sSS with versus without double positivity for ACPA and SSA had greater RA disease burden at baseline and 12-month follow-up. Further analysis with a larger sample size is warranted.

Table 1. Baseline Characteristics of Pts With sSS With and Without ACPA and SSA Positivity

Double+ pts with sSS

Pts with sSS without double positivity*

p value

N

Mean (SD)

N

Mean (SD)

Age, years

80

54.6 (13.9)

86

55.1 (13.5)

0.683

Age at RA diagnosis, years

80

41.3 (14.3)

85

48.7 (13.5)

0.001

RA symptoms duration, years

80

15.3 (12.8)

85

10.0 (10.5)

0.001

Female, n (%)

80

74 (92.5)

86

79 (91.9)

0.878

BMI

71

27.5 (7.6)

69

27.6 (5.9)

0.388

RADAI

72

4.0 (2.4)

80

4.0 (2.1)

0.896

DAS28 (CRP)

66

4.0 (1.8)

69

3.5 (1.4)

0.072

CDAI

64

25.1 (19.2)

67

17.9 (13.6)

0.065

Number of swollen joints

74

7.4 (7.5)

76

4.0 (5.3)

0.002

Number of painful joints

74

9.3 (9.3)

76

6.2 (6.5)

0.105

Total swollen painful joints

74

16.8 (15.6)

76

10.2 (10.8)

0.021

MDHAQ fatigue scale

72

47.4 (30.4)

80

53.5 (29.9)

0.252

Comorbidities, n (%)

Vasculitis, cutaneous

80

7 (8.8)

86

0 (0.0)

0.005

Vasculitis, other

80

2 (2.5)

86

1 (1.2)

0.609

Lymphoma

80

1 (1.3)

86

0 (0.0)

0.482

Neuropathy

80

2 (2.5)

86

4 (4.7)

0.683

Lung cancer

80

0 (0.0)

86

1 (1.2)

1.000

Pulmonary fibrosis

80

1 (1.3)

86

0 (0.0)

0.483

Pulmonary nodules

80

3 (3.8)

86

1 (1.2)

0.353

Values are mean (SD) unless otherwise stated

*Includes single positive and double negative pts

ACPA=anti-citrullinated protein antibodies; double+=double positive; MDHAQ=Multidimensional Health Assessment Questionnaire; pts=patients; RADAI=Rheumatoid Arthritis Disease Activity Index; SSA=Sjögren’s-syndrome-related antigen A; sSS=secondary Sjögren’s Syndrome

Table 2. Change in Disease Activity Measures and Fatigue at 12 Months

12 months

Change from baseline

sSS pts with ACPA and Ro positivity

sSS pts without ACPA and/or Ro positivity

sSS pts with ACPA and Ro positivity

sSS pts without ACPA and/or Ro positivity

p value for change from baseline

RADAI

N

3.7 (2.3)

64

3.6 (2.0)

70

−0.3 (2.0)

64

−0.2 (1.4)

70

0.427

DAS28 (CRP)

N

3.9 (1.8)

47

2.8 (1.2)

50

−0.1 (1.6)

47

−0.6 (1.3)

50

0.149

CDAI

N

23.0 (20.6)

47

12.5 (11.1)

45

−0.8 (19.8)

47

−4.2 (12.3)

45

0.702

Swollen joint count

N

6.7 (8.2)

60

1.9 (4.1)

59

−1.0 (7.6)

60

−1.7 (4.0)

59

0.911

Painful joint count

N

7.7 (8.4)

60

3.6 (5.7)

59

−1.3 (8.7)

60

−2.1 (6.4)

59

0.808

Total joint count

N

14.4 (16.5)

60

5.6 (8.3)

59

−2.2 (15.2)

60

−3.7 (8.9)

59

0.934

Fatigue scale

N

49.2 (27.4)

64

46.9 (24.9)

69

2.1 (24.5)

64

−5.6 (21.0)

69

0.082

Value are mean (SD) N

ACPA=anti-citrullinated protein antibodies; pts=patients; RADAI=Rheumatoid Arthritis Disease Activity Index; sSS=secondary Sjögren’s Syndrome

Disclosure: E. Alemao, Bristol-Myers Squibb, 1, 3; Y. Saini, Mu-sigma, 5; Y. Bao, Bristol-Myers Squibb, 1, 3; A. Rao, Mu Sigma for Bristol-Myers Squibb, 5; C. K. Iannaccone, None; M. Frits, None; M. E. Weinblatt, Amgen, Crescendo Bioscience, Bristol-Myers Squibb, Sanofi/Regeneron, 2,AbbVie, Ablynx, Amgen, Bristol-Myers Squibb, Canfite, Corrona, Crescendo, GSK, Gilead, Lilly, Lycera, Merck, Momenta, Novartis, Pfizer, Roche, Samsung, Set Point, UCB, Vertex, 5; N. A. Shadick, Amgen, Mallinckrodt, Bristol-Myers Squibb, Sanofi-Regeneron, 2,Bristol-Myers Squibb, 5.

To cite this abstract in AMA style:

Alemao E, Saini Y, Bao Y, Rao A, Iannaccone CK, Frits M, Weinblatt ME, Shadick NA. Do Anti-Citrullinated Protein Antibodies and Anti-Sjögren’s-Syndrome-Related Antigen a Double Positive Patients with Secondary Sjögren’s Syndrome and RA Have Higher Joint Disease Activity? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/do-anti-citrullinated-protein-antibodies-and-anti-sjogrens-syndrome-related-antigen-a-double-positive-patients-with-secondary-sjogrens-syndrome-and-ra-have-higher-joint-disease-activity/. Accessed .

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