Identification of Joint Locations That Are Poor Prognostic in an Early Seropositive Erosive RA Cohort

Patrick Durez¹, Sofie Robert², Alexandra Thiry³ and Harris A Ahmad³, ¹Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium, ²Bristol-Myers Squibb, Braine L’Alleud, Belgium, ³Bristol-Myers Squibb, Princeton, NJ

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Early Rheumatoid Arthritis, Examination, prognostic factors and synovitis

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: Patients (pts) with early RA often present with multiple and different areas of joint involvement. While the ACR and EULAR guidelines specify high disease activity, erosions, seropositivity and other factors for a poor prognostic RA, limited data exist to identify which specific joints or joint locations may be indicative of disease severity and poorer prognosis.¹ This analysis investigated the distribution of affected joints at baseline (BL) as well as the correlation between BL swollen joint status and disease characteristics and prognostic factors in early RA pts. Methods: Data from AGREE (NCT00122382), a double-blind Phase III study of abatacept (ABA) plus methotrexate (MTX) (n=256) vs MTX (n=253) in MTX-naïve pts who were seropositive for RF and/or ACPA with early (≤2 years [yrs]) erosive RA, were analyzed post hoc by baseline swollen joint status (present, absent) for 8 different joint locations: hands, wrists, elbows, shoulders, jaw, knees, ankles and feet. Pairwise associations of BL swollen joint status were evaluated for all evaluable joint locations. Overall characteristics and study results were previously reported.² Results: In this early RA cohort with poor prognostic factors, (n=509), BL swelling was most frequently observed in the hands (99%), followed by the wrist (92%), ankle (79%), knee (69%), foot (66%), elbow (48%), shoulder (34%) and jaw (9%). Pts with a BL swollen knee, jaw, elbow or wrist have a poorer prognosis and more aggressive RA. When these joints were involved in this MTX-naïve, seropositive, early erosive cohort, these pts had more tender and swollen joints, higher DAS28(CRP), SDAI and CDAI than those without swelling (Table 1). Higher HAQ-DI was seen in pts with a swollen knee versus those without knee swelling (1.8 [0.6] vs 1.5 [0.7], respectively (p < 0.001)). Swollen shoulder status was significantly associated with swelling status of almost all other joint locations (elbow, foot, jaw and knee: p < 0.001), whereas swelling status of the foot and wrist were the least associated with swelling status of other joints (Table 2). Presence of BL synovitis was not associated with greater BL ACPA or RF positivity, probably due to the inclusion of mainly seropositive pts.

Conclusion: In this cohort of early, seropositive erosive RA, swelling in the knee, jaw, wrist or elbow suggest that large joint locations are associated with the poorest prognosis. Pts with such a presentation might be considered for more intensive treatment.

References: 1. Bergstra SA, et al. RMD Open 2017;3:e000568 2. Westhovens R, et al. Ann Rheum Dis 2009;68:1870–7

Disclosure: P. Durez, BMS, Lilly, Sanofi, Pfizer, 8; S. Robert, Bristol-Myers Squibb, 3; A. Thiry, Bristol-Myers Squibb, 3,Bristol-Myers Squibb RSUs, 1; H. A. Ahmad, Bristol-Myers Squibb, 1, 3.

To cite this abstract in AMA style:

Durez P, Robert S, Thiry A, Ahmad HA. Identification of Joint Locations That Are Poor Prognostic in an Early Seropositive Erosive RA Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/identification-of-joint-locations-that-are-poor-prognostic-in-an-early-seropositive-erosive-ra-cohort/. Accessed .

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