Morning Stiffness Already Associates with Systemic Inflammation and Subclinical Joint Inflammation in the Pre-RA Phase of Arthralgia

Doortje Krijbolder¹, Fenne Wouters¹, Elise van Mulligen² and Annette H.M van der Helm-van Mil¹, ¹Leiden University Medical Center, Leiden, Netherlands, ²Erasmus Medical Center, Rotterdam, Netherlands

Meeting: ACR Convergence 2021

Keywords: C-reactive protein (CRP), Inflammation, Magnetic resonance imaging (MRI), Morning Stiffness, rheumatoid arthritis

Session Information

Date: Monday, November 8, 2021

Title: RA – Diagnosis, Manifestations, & Outcomes Poster III: Prediction, Biomarkers, & Treatment Response (1196–1222)

Session Type: Poster Session C

Session Time: 8:30AM-10:30AM

Background/Purpose: Morning stiffness (MS) is characteristic for Rheumatoid Arthritis (RA) and associates with markers of systemic and local inflammation in RA-patients. In patients with arthralgia, MS is a cardinal symptom to recognize arthralgia at-risk for RA-development (i.e. clinically suspect arthralgia, CSA). In CSA, MS is also assumed to reflect inflammation, but this has never been studied. Therefore we aimed to study whether MS in CSA-patients is associated with systemic- and subclinical joint-inflammation.

Methods: 575 patients presenting with CSA underwent laboratory investigations and contrast-enhanced 1.5T-MRI of hand and forefoot (scored according to the RAMRIS-method). Associations of MS (duration ≥60 minutes) with presence of subclinical synovitis, tenosynovitis and osteitis with increased CRP (≥5 mg/L) were determined with logistic regression. Additionally, the effect of MS-duration (≥30, ≥60, ≥120 minutes) was studied.

Results: The mean age of the study population was 44 years (SD 13), 439 patients (76%) were female, median tender joint count (TJC68) was 5 (IQR 2-10), and 79 (14%) patients were ACPA-positive. 195 (34%) CSA-patients experienced MS. These patients more often had subclinical synovitis (34% versus 21%, OR 1.95 (95%CI 1.32-2.87)), subclinical tenosynovitis (36% versus 26%, OR 1.59 (1.10-2.31)) and increased CRP (31% versus 19%, OR 1.93 (1.30-2.88)) than patients without MS. In multivariable analyses, subclinical synovitis (OR 1.77 (1.16-2.69)) and CRP (OR 1.78 (1.17-2.69)) remained independently associated with MS. In CSA-patients who later developed RA, and thus in retrospect were ‘pre-RA’ at time of CSA, MS was more strongly associated with subclinical synovitis (OR 2.56 (1.04-6.52)) and CRP (OR 3.86 (1.45-10.24)). Furthermore, associations increased with longer MS-durations.

Conclusion: Inflammation indeed contributes to MS, already in the CSA-phase that preceded clinical arthritis. These results increase understanding of MS when assessing arthralgia in clinical practice.

Disclosures: D. Krijbolder, None; F. Wouters, None; E. van Mulligen, None; A. van der Helm-van Mil, None.

To cite this abstract in AMA style:

Krijbolder D, Wouters F, van Mulligen E, van der Helm-van Mil A. Morning Stiffness Already Associates with Systemic Inflammation and Subclinical Joint Inflammation in the Pre-RA Phase of Arthralgia [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/morning-stiffness-already-associates-with-systemic-inflammation-and-subclinical-joint-inflammation-in-the-pre-ra-phase-of-arthralgia/. Accessed .

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