Background/Purpose: Although telemedicine in rheumatoid arthritis (RA) could improve disease control with lower healthcare costs, knowledge of suitable parameters for self-testing disease activity still remains limited. The alteration in lipoproteins among RA patients seems to be associated with disease activity and severity. Objective: To explore the relationship between disease activity and a set of serum inflammatory and lipid biomarkers and patient and physician evaluations in RA.

Methods: Activity markers (CRP, ESR, swollen (SJC) & tender (TJC) joint counts), serum lipids and patient health status evaluation using the visual analogous scale (VAS) completed by the patient and clinician were analysed at two-time points in a real-world cohort of patients with RA (n=22, males/females, 4/18) using patient similarity networks (PSNs). Disease activity was assessed by DAS28 at each visit, and most patients were treated with biologics (inhibitors of TNFa/JAK/IL6/others: 12/3/2/5).

Results: When comparing patient and physician evaluations, patient evaluations differed significantly from physician evaluations in ~1/3 of patients (differences in SJC >5, TJC >3, and/or VAS >30), mainly with overestimated values of SJC and VAS health status by patients. Therefore, we constructed a PSN based only on laboratory parameters and revealed three clusters (subgroups) of patients who differed in CRP, low-density lipoprotein cholesterol (LDL-C), and apolipoprotein-AI (apoA-I) levels, all three of which have been associated with RA disease activity in previous studies. One subgroup (CI) characterised by a low CRP and high LDL-C and apoA-I included predominantly non-active patients (6/9, confidence C=67%, support S=41%). The majority of these patients changed to active after the 3-month follow-up. Two subgroups: CII) with low CRP and LDL-C (5/6, C=83%, S=27%), and CIII) with high CRP and LDL-C and low apoA-I (6/7, C=86%, S=32%) included predominantly active patients. Our data support a key role for serum apoA-I levels in activity assessment, as these levels are strongly related to disease activity at follow-up. The expansion of the study cohort is ongoing.

Conclusion: Our study shows the utility of serum biomarkers for assessing disease activity, independent of the patient and clinician evaluations. Whether the nominated biomarkers are suitable for the automated approach, clinical use and/or interpretation of cardiovascular risk or even sorting active patients in telemedicine approach, deserves future validation on a larger patient cohort.

Grant support: IGA_LF_2023_10, IGA_LF_2023_002, MH CZ – DRO (FNOL, 00098892)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/nomination-of-biomarkers-for-self-testing-disease-activity-in-rheumatoid-arthritis-using-patient-similarity-networks-a-pilot-study/