Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Preclinical rheumatoid arthritis (pre-RA) describes a subset of patients with arthralgia (but no synovitis) where either anti-citrullinated peptide antibodies (ACPA) and/or rheumatoid factor (RF) can be found, but without clinical synovitis, where there was no evidence of clinical RA, and no disease-modifying anti-rheumatic drug (DMARD) therapy was initiated. Recent data indicate that 35% of these patients develop arthritis after 12 months (van de Stadt et al, 2012). The objective of this investigation was to follow the course of disease in patients with pre-RA by means of a telephone survey, and evaluate how many patients develop clinical RA.
Methods:
In a retrospective analysis, we identified patients with pre-RA who presented in the early arthritis clinic (EAC) of the Department for Rheumatology and Clinical Immunology of Charité – Universitätsmedizin Berlin between 2004 and 2011. All patient had given written consent to be contacted in the future. Approval from the local ethics committee was present. All patients were called who were in our EAC at least 12 months ago. The follow-up questionnaire included questions about tender and swollen joints, overall pain, current antirheumatic therapy, and whether a diagnosis of RA has been established. Descriptive statistical analysis was performed using SPSS.
Results:
47 patients (pts) with pre-RA out of 1,400 pts of our EAC (3.4%) were identified. 23 of these pts (49%) agreed to participate in the telephone survey. 14 (61%) pts were female. The mean age was 54 (standard deviation (SD) ± 15) years. Mean duration between first contact in EAC and follow-up was 6 (SD ± 2) years. RF >20 U/ml was present in 20 pts (87%) with a mean serum level of 86 ± 144 U/ml in RF positive pts, ACPA >20 U/ml ± were present in 7 pts (30%) with a mean serum level of 28 ± 68 U/ml. RF and ACPA were simultaneously present in 4 pts (17%).
When asked about the course of their symptoms including joint pain and joint swelling, 5 pts (22%) stated that they were now free of complaints, in 10 pts (44%) complaints were improved, in 5 (22%) they were unchanged, in 3 (13%) they had reappeared, and in none of the pts (0%) had complaints deteriorated.
3 pts (13%) developed clinical RA after a duration of 1, 3, and 6 years, respectively. These 3 pts are currently taking DMARD therapy (2 Methotrexate, 1 Leflunomide). 2 of these patients are RF positive (serum level 33 and 74 U/ml, respectively), 1 patient is ACPA positive (70 U/ml). None of the patients are double positive.
Conclusion:
The overall risk of developing clinical RA in this cohort of pre-RA patients was low (13%). Serum levels of RF or ACPA were not predictive for the development of RA, and neither was double positive antibody status associated with a higher risk for RA. Large prospective cohorts are needed to confirm these findings.
Disclosure:
P. Klaus,
None;
V. Köhler,
None;
H. Bastian,
None;
T. Braun,
None;
E. Gremmelsbacher,
None;
V. Höhne-Zimmer,
None;
F. Buttgereit,
None;
G. Burmester,
AbbVie Inc., BMS, Merck, Roche, Pfizer, and UCB,
2,
AbbVie Inc., BMS, Merck, Roche, Pfizer, and UCB,
5,
AbbVie Inc., BMS, Merck, Roche, Pfizer, and UCB,
8;
J. Detert,
Abbott Immunology Pharmaceuticals,
2.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/follow-up-of-patients-with-preclinical-rheumatoid-arthritis-results-of-a-telephone-survey/