The Clinical and Radiographic Course of Early Undifferentiated Arthritis Under Treatment Is Not Dependent on the Amount of Erosions at Diagnosis. Results from the Swiss Prospective Observational Cohort

Ruediger Mueller¹, Toni Kaegi², Sarah Haile³ and Johannes von Kempis⁴, ¹Rheumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland, ²Division of Rheumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland, ³Division of Biostatistics, Institute for Social and Preventive Medicine,, University of Zurich, Switzerland, Zurich, Switzerland, ⁴Rheumatology, St. Gallen Hospital, CH- 9007 St.Gallen, Switzerland

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Diagnostic criteria, Early Rheumatoid Arthritis, prognostic factors, radiography and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects VI: Impact of Treatment and Other Interventions

Session Type: Abstract Submissions (ACR)

Background/Purpose

To analyse whether early arthritis patients who do not fulfil the ACR/EULAR 2010 classification criteria for rheumatoid arthritis (RA) have a different course of the disease dependent on whether they can or cannot be classified as RA because of radiographic disease (as recently defined by the EULAR task force) at diagnosis.

Methods

For this observational study within the Swiss RA cohort SCQM, we included patients with early undifferentiated arthritis (disease duration ≤1 year), as diagnosed by the treating rheumatologist, who had not received any previous DMARDs. 2010 ACR/EULAR criteria negative patients were separated into 2 groups (radiographic vs. non radiographic arthritis) depending on whether or not they had radiographic changes recently defined as erosive disease by a EULAR task force (≥3 joints with erosions). The primary outcome measure was the radiographic progression detected employing the Ratingen erosion score. HAQ and DAS 28 were used as secondary outcome measures. The average observation period was 4 years.

Results

A total number 592 patients was analysed. 240 were not classifiable as RA by application of the 2010 ACR/EULAR criteria at baseline. 133 of these patients had radiographic arthritis and 50 non-radiographic arthritis. In 57 patients radiographs at the first visit were not available. Treatment was initiated in all patients with DMARDs, mostly MTX. There were no significant differences in the therapeutic strategies between radiographic and non-radiographic patients. No differences in DAS 28 and HAQ scores were found during follow up over 4 years. The average erosion scores were higher among patients with initially radiographic arthritis throughout the study. The progression of erosion scores over time, however, was higher in initially non radiographic arthritis patients (3.3 erosions/year vs. 0.4, resp., p<0.0001).

Conclusion

The clinical and radiographic course of early undifferentiated arthritis under treatment was not dependent on the presence of erosions in 3 or more joints (i.e. the definition of radiographic disease by the EULAR taskforce) at diagnosis in our cohort.

Disclosure:

R. Mueller,
None;

T. Kaegi,
None;

S. Haile,
None;

J. von Kempis,

AbbVie, Antares Pharma, Bristol-Myers Squibb, MSD, Pfizer, Roche, and UCB,

ristol-Myers Squibb, Roche, and UCB,

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