ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1449

Evaluation of Progression from Preclinical to Systemic Autoimmune Rheumatic Disease

Joan Wither1, Dennisse Bonilla2, Zareen Ahmad1, Arthur Bookman3, Linda Hiraki4, Earl Silverman5, Mohammad Movahedi1, Sindhu Johnson6 and Hana Salem Alahmari7, 1University of Toronto, Toronto, ON, Canada, 2University Health Network, Toronto, ON, Canada, 3Toronto Western Hospital, Toronto, ON, Canada, 4The Hospital for Sick Children, Toronto, ON, Canada, 5Silverman, Toronto, ON, Canada, 6Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada, 7Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada

Meeting: ACR Convergence 2023

Keywords: ,

Session Information

Date: Monday, November 13, 2023

Title: (1442–1487) SLE – Diagnosis, Manifestations, & Outcomes Poster II

Session Type: Poster Session B

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

Background/Purpose: To evaluate the development of a systemic autoimmune rheumatic disease (SARD) in undifferentiated and asymptomatic individuals with antinuclear antibodies (ANA). We evaluated fulfillment of classification criteria and comparatively evaluated manifestations between those who did and did not develop a SARD.

Methods: We conducted a retrospective cohort study of undifferentiated (UCTD) and asymptomatic patients with ANA who were assessed at baseline and annually for developing signs, symptoms, and serology of a SARD. The primary outcome was a physician-based diagnosis of SARD over two years. We assessed fulfillment of classification criteria and used risk ratios (RR) to evaluate differences in manifestations in those who did and did not progress to a SARD.

Results: We evaluated 207 asymptomatic ANA+ or UCTD subjects, of whom 20 (9.7%) progressed to a SARD while 187 (90.3%) did not progress. Progressors developed systemic lupus erythematosus (SLE) (n=11 (55%)), Sjogren’s disease (n=5 (25%)), systemic sclerosis (n=3 (15%)) and rheumatoid arthritis (n=1 (5%)). Fever occurred less frequently in those who progressed to a SARD (RR 0.90, 95%CI 0.86, 0.94). Among SLE patients, 100% fulfilled the EULAR/ACR SLE criteria (sensitivity 91.7%, specificity 100%), whereas 73% fulfilled the 1997 ACR SLE criteria (sensitivity 81.8%, specificity 98.9%). Progressors to SLE had arthritis (91%), hypocomplementemia (45%), alopecia (36%), oral ulcers (27%), acute cutaneous lupus (18%), subacute cutaneous lupus (18%), and pericarditis (18%); while none developed delirium, psychosis, seizures, or lupus nephritis.

Conclusion: Most undifferentiated/asymptomatic individuals with ANA do not progress to a SARD over two years. The EULAR/ACR SLE criteria have improved the ability to identify those who develop SLE. SLE progressors appear to have mild disease in the short term.

Disclosures: J. Wither: None; D. Bonilla: None; Z. Ahmad: None; A. Bookman: GlaxoSmithKline(GSK), 12, Regional Principal Investigator, Novartis, 12, Regional Principal Investigator, VIELA BIO, 12, Regional Principal Investigator; L. Hiraki: None; E. Silverman: None; M. Movahedi: None; S. Johnson: None; H. Alahmari: None.

To cite this abstract in AMA style:

Wither J, Bonilla D, Ahmad Z, Bookman A, Hiraki L, Silverman E, Movahedi M, Johnson S, Alahmari H. Evaluation of Progression from Preclinical to Systemic Autoimmune Rheumatic Disease [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/evaluation-of-progression-from-preclinical-to-systemic-autoimmune-rheumatic-disease/. Accessed .

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