ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2499

Predictors of Rheumatoid Arthritis Development in Patients with Early Undifferentiated Arthritis: A 2-Years Follow-up Study

Juan Molina1, Maria Gabriela Gonzalez Álvarez2, Victoria Navarro-Compán3, Laura Nuño4, Alejandro Villalba2, Diana Peiteado2, Patricia Bogas2 and Alejandro Balsa2, 1Rheumatology, Rheumatology, La Paz University Hospital, Madrid, Spain, 2Hospital Universitario La Paz, Madrid, Spain, 3Immuno-Rheumatology research group, IdiPaz. La Paz University Hospital, Madrid, Spain, 4Rheumatology, La Paz University Hospital, Madrid, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords:

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Early treatment of RA improves longterm outcomes. However, at the beginning of the disease, some patients with RA fall within undifferentiated arthritis (UA) patients. Almost half of patients with UA may experience spontaneous remission. So, in order to prevent overtreatment and poor outcomes, the identification of predictors of RA development is desirable. The objective of this research is to determine the frequency of patients with UA evolving into RA after 2 years of follow-up and the factors contributing to predict this outcome.

Methods: A prospective analysis of an early arthritis cohort of 1377 patients from 1993 to 2017 was undertaken. For this study, 2-years follow-up data of patients who presented with UA were analyzed. A detailed baseline assessment was completed including clinical features, physical examination and laboratory tests. Patients were stratified in two groups based on progression to RA (according to physician´s diagnosis) or to another disease (non-RA). First, differences between groups were tested using chi-squared and Student-t tests in the univariate analysis. Second, multivariate logistic regression models were employed to investigate the association between possible predictive factors and RA development.

Results: A total of 471 UA patients were included for analysis. Mean age was 48.7±17.5 years, 352(74.9%) were females, and mean symptoms duration was 13.9±13.9 weeks. After 2 years of follow-up, 93 (19.7%) of UA patients evolved into RA. Meanwhile, 175 (37.2%) remained undifferentiated and 203 (43.1%) developed into other musculoskeletal diseases.  Baseline characteristics between both groups are compared in Table 1. In the univariate analysis, the presence of rheumatoid factor (RF) and anti-citrullinated peptides antibodies (ACPA), tender and swollen joint count, duration of morning stiffness, smoking, symmetry and ESR values were significantly associated with RA development. In the multivariate analysis, RF(OR= 5,899; 95%CI 1,795-19,382), ACPA (OR= 123,238; 95%CI 29,353-517,410) and swollen joint count (OR=1,233; 95%CI 1,048-1,450), remained significantly associated with RA development (Table 2).

Conclusion: Approximately,1 out of 5 patients with UA evolves into RA after 2-years of follow-up. Swollen joint count, and the presence of rheumatoid factor (RF) and anti-citrullinated peptides antibodies (ACPA) are independent predictors for the development of RA, supporting the early DMARDs initiation in such patients.

Table 1. Baseline characteristics of patients with UA

Total

n= 471

RA

n=93 (19.7%)

Non RA

n=378 (80.3%)

p

Age

48.7±17.5

48.5±15.7

48.7±18

0.8

Sex

Female

352(74.9%)

77(82.8%)

275 (72.9%)

0.1

Race

n= 332

Caucasian

274(82.5%)

65(83.3%)

209 (82.3%)

0.01

Arabian

1(0.3%)

0(0%)

1(0.4%)

Asiatic

2 (0.6%)

0(0%)

2 (0.8%)

Hispanic

52 (15.7%)

11(14.1%)

41(16.1%)

Black

3(0.9%)

2 (2.6%)

1(0.4%)

Smoking

n= 441

Non smoker

238 (54%)

36 (39.1%)

202 (57.9%)

0.001

Smoker

113 (25.6%)

30 (32.6%)

83 (23.8%)

Former smoker

90 (20.4%)

26 (28.3%)

64 (18.3%)

Extension

Monoarticular

59 (12.7%)

6 (6.5%)

53 (14.2%)

0.1

Oligoarticular

209 (44.8%)

38 (40.9%)

171 (45.8%)

Polyarticular

198 (42.5%)

49 (52.7%)

149 (39.9%)

Affectation

Acute

142 (30.4%)

14 (15.1%)

128 (34.2%)

0.001

Subacute

325 (69.6%)

79 (84.9%)

246 (65.8%)

Time (weeks) from symptoms onset n=401

13.9±13.9

18±12.4

12.9±14

0.03

Morning stiffness (minutes)

n=445

72.5±187.3

84.3±164.3

69.6±192.6

0.5

Pain (VAS 0-100) n=430

44.8±27.6

47.8±27.3

44±27.7

0.2

Patient Global Assessment

(0-100) n=439

42.7±27.5

46.2±26

41.8±27.9

0.1

Phisician Global Assessment

(0-100) n=361

28.7±21

34.2±22.3

27.1±20.4

<0.001

HAQ n=421

7.41±5.8

8.2±5.5

7.2±5.9

0.1

28 Tender Joint Count

4.7±5.5

6.42±6.1

4.3±5.3

0.001

28 Swollen Joint Count

3.2±4.2

4.6±5.4

2.8±3.7

<0.001

ESR (mm/h) n=449

26.6±21.9

31.8±21.2

25.2±21.9

0.010

CRP (mg/L) n=438

2.8±8.2

1.9±2.8

3.08±9

0.2

RF (IU/mL)

40.7±144.7

133.5±243.1

17.5±94.1

<0.001

ACPA (IU/mL) n=454

129.7±425.6

579.5±762.9

15.41±126.2

<0.001

Table 2. Independent predictors of RA development based on logistic regression model

Odds ratio

95% C.I.

Lower

Upper

Phisician Global Asessment  (0-100)

1,016

,983

1,051

28 Tender Joint Count

,949

,852

1,057

28 Swollen Joint Count

1,233

1,048

1,450

ESR(mm/h)

1,018

,992

1,044

Race

,633

,021

19,250

Smoking

,851

,223

3,245

Symmetry

,568

,145

2,225

RF(IU/mL)

5,899

1,795

19,382

ACPA(IU/mL)

123,238

29,353

517,410
Disclosure: J. Molina, None; M. G. Gonzalez Álvarez, None; V. Navarro-Compán, None; L. Nuño, None; A. Villalba, None; D. Peiteado, None; P. Bogas, None; A. Balsa, None.

To cite this abstract in AMA style:

Molina J, Gonzalez Álvarez MG, Navarro-Compán V, Nuño L, Villalba A, Peiteado D, Bogas P, Balsa A. Predictors of Rheumatoid Arthritis Development in Patients with Early Undifferentiated Arthritis: A 2-Years Follow-up Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/predictors-of-rheumatoid-arthritis-development-in-patients-with-early-undifferentiated-arthritis-a-2-years-follow-up-study/. Accessed .

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