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Abstract Number: 870

How To Predict That Early Arthritis Without Rheumatoid Factor and ACPA Becomes Rheumatoid Arthritis According To ACR/EULAR 2010 After a 3-Years Follow-Up? Results From The Espoir Cohort

Gaël Mouterde1, Cédric Lukas2, Nathalie Rincheval3, Alain Saraux4, Philippe Dieude5 and Bernard Combe6, 1Rheumatology, Montpellier 1 University, Lapeyronie Hospital, Montpellier, France, 2Immuno-Rhumatologie, Hopital Lapeyronie, Montpellier, France, 3Institut Universitaire de Recherche Clinique, Montpellier, France, 4Department of rheumatology and unit of immunology (EA 2216), CHU Brest et Université Bretagne Occidentale, Brest, France, 5Rheumatology, Rheumatology departement & INSERM U699, Paris Diderot university, APHP, Bichat hospital, Paris, France, 6Rheumatology, Lapeyronie Hospital, Montpellier I university, Montpellier, France

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: ACPA, Classification criteria and rheumatoid arthritis (RA), Early Rheumatoid Arthritis, Rheumatoid Factor

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Session Information

Title: Rheumatoid Arthritis - Clinical Aspects II: Identifying Rheumatoid Arthritis in At-Risk Populations

Session Type: Abstract Submissions (ACR)

Background/Purpose: To describe disease course of patients without rheumatoid factor (RF) and anti-citrullinated protein auto-antibodies (ACPA) in an inception cohort of early arthritis patients. To determine baseline predictors of development of rheumatoid arthritis (RA) according to ACR/EULAR 2010 criteria at 3 years in these patients.

Methods: Patients presenting with synovitis of at least 2 joints for 6 weeks to 6 months were included in the multicenter French ESPOIR cohort. Following data were collected at baseline for those who were negative for IgM RF and ACPA (anti-CCP2): clinical and biological features of arthritis, HLA-DRB1* typing, socio economic factors, comorbidities, radiographs of hands, wrists, and feet (modified Sharp score). RA was defined according to the 2010 ACR/EULAR classification criteria (1) at any visit during the first 3 years of follow-up or by typical RA erosion (2). Alternative diagnoses were reported among patients who did not fulfill ACR/EULAR criteria. Logistic regression was performed to evaluate the association between RA diagnosis at 3 years and baseline variables.

Results: Of the 813 recruited patients, 406 (49.9%) were negative for both RF and anti-CCP2. They had the following characteristics: age 49±13 years, females 77%, mean disease duration: 102+/-50 days, median morning stiffness: 45mn [IQR 15 – 90], median pain at rest: 34/100 [IQR 12 – 58], median tender joint count (TJC) 6 [IQR 3 – 13], DAS28 4.95±1.3, HAQ score 0.93±0.68, CRP 18.6±34.2 mg/l. 70 (19.3%) patients had typical RA erosions on X-ray; 57 (14.1%) had antinuclear antibodies (ANA) and 39 (9.6%) were RF-IgA positive. 246/387 patients (63.6%) fulfilled ACR/EULAR 2010 criteria for RA at baseline and 269/374 (71.9%) at 3 years. In this seronegative cohort, diagnosis of RA at 3 years was associated with the following initial factors: symmetric involvement (OR=3 [1.41; 6.39], p=0.004), morning stiffness (>median: 45 min) (OR=2.48 [1.34; 4.57], p=0.004), pain at rest on a VAS (>median: 34/100) (OR=2.14 [1.14; 4.01], p=0.017), number of tender joints (>median: 6) (OR=3.51 [1.78; 6.92], p<0.001) and presence of feet erosions (OR=2.96 [1.19; 7.40], p=0.020). Presence of ANA (OR=0.38 [0.17; 0.87], p=0.021), transaminases elevation (OR=0.52 [0.28; 0.94], p=0.032) and living in the south of France (OR=0.45 [0.22; 0.90], p=0.024) had a protective effect against progression to RA. No association between extra-articular manifestations, HLA-DR3 and “seronegative RA” was observed. Among the 105 patients who did not fulfill ACR/EULAR 2010 criteria for RA at 3 years, 44 had another definite diagnosis: psoriatic arthritis (n=10), spondyloarthritis (n=7), erosive hand osteoarthritis (n=5), connective tissue disease and vasculitis (n=8), polymyalgia rheumatica or RS3PE syndrome (n=3).

Conclusion: Patients with early arthritis and without RF and ACPA are more prone to have RA at 3 years if they have inflammatory pain, symmetric involvement of numerous joints and typical feet erosions. Detection of ANA and transaminases elevation should suggest non RA diagnosis.


Disclosure:

G. Mouterde,
None;

C. Lukas,
None;

N. Rincheval,
None;

A. Saraux,

Roche Pharmaceuticals,

2,

Roche Pharmaceuticals,

5;

P. Dieude,

Roche, Pfizer, BMS,

2,

Roche, Pfizer, BMS,

5;

B. Combe,
None.

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