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:
The development of ultrasound (US) guided synovial biopsy will enable synovial tissue collection from small joints and will facilitate histopathological studies, thus improving the understanding of early rheumatoid arthritis (ERA). The CAP48 cohort is an original multicentre prospective observational study of ERA patients (pts) up to 50 years old supported by a charity program of the Belgian French speaking radio-television (RTBF). The objectives of this cohort are to observe if a tight control favours remission at 6 months and to define synovial markers for disease severity and response to therapy.
Methods:
ERA pts fulfilling the ACR/EULAR 2010 criteria and naive to DMARDs therapy were recruited. Synovial biopsies before treatment were obtained using an US guided needle biopsy (US-NB) of the small joints or miniarthroscopy of the knee and used for blinded tissue pathotype description. ERA disease activity measures including DAS28CRP were evaluated every 3 months and treatment was adapted by the treating physician. Tissues were assessed for quality. Pts were classified according 3 types of synovial histopathology findings: pts whose synovial tissue showing mostly lymphoid (CD3+ and CD20+) infiltrates, myeloid (CD68+) infiltrates and a group with low inflammation, combined or not with a fibroid aspect of the stroma, clustered, respectively in Lymphoid, Myeloid and Pauci-Immune groups.
Results:
A synovial biopsy was performed in 37 pts. Baseline characteristics of the cohort and different histologic pattern groups are summarized in Table.
|
All patients n=37 |
‘Lymphoid’ group n=18 |
‘Myeloid’ group n=6 |
‘Pauci-Immune’ group n=13 |
|
|
Age mean (SD) |
34.6 (± 11.6) |
31.2 (± 10.9) |
38.4 (± 11.7) |
37.7 (± 11.9) |
|
Gender |
30F/7M |
14F/4M |
5F/1M |
11F/2M |
|
ACPA % |
37.8% (n= 14) |
22.2% (n=4) |
0% (n=6) |
76.9% (n=10) |
|
RF % |
48.6% (n=18) |
38.9% (n=7) |
16.7% (n=1) |
76.9% (n=10) |
|
Erosion % |
32.4% (n=12) |
27.8% (n=5) |
33.3% (n=2) |
38.4% (n=5) |
|
Baseline DAS28CRP |
4.60 (± 1.37) |
4.46 (± 1.42) |
5.24 (± 1.52) |
4.50 (± 1.26) |
|
6 Month DAS28CRP |
2.68 (± 1.13) |
2.19 (± 0.89) * |
2.83 (± 1.44) |
3.15 (± 1.13) * p=0.023 |
ACPA negative pts were classified in the Myeloid (100%) or in Lymphoid (77.8%) groups compared to a majority of the ACPA positive pts (76.9%) in the Pauci-Immune group. Since the myeloid pattern can be associated with a lymphoid infiltration, it raised a question on the relevance to maintain a distinct subgroup. The Pauci-Immune RA group showed lower DAS28-CRP response than the other groups.
Conclusion:
Synovial tissue analysis could provide a step change towards personalized medicine in daily clinical practice for disease stratification and treatment selection of ERA. In the CAP48 cohort, a high number of these young and ERA pts achieved remission at 6 months but a lower response was observed in the Pauci-Immune group. Further analyses are ongoing to define individual synovial markers of severity and response.
To cite this abstract in AMA style:
Galant C, Meric de Bellefon L, Lauwerys BR, Sokolova T, Stoenoiu M, Badot V, Nzeusseu Toukap A, Houssiau FA, Durez P. Synovial Tissue Histopathology Findings in EARLY RA. Is It Usefull? Analysis of the Belgian CAP48 Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/synovial-tissue-histopathology-findings-in-early-ra-is-it-usefull-analysis-of-the-belgian-cap48-cohort/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/synovial-tissue-histopathology-findings-in-early-ra-is-it-usefull-analysis-of-the-belgian-cap48-cohort/