The Clinical and Ultrasonographic Presentation of Seronegative RA Is More Severe Compared to Seropositive RA in an Inception Cohort of DMARD-Naïve Patients Classified According to the 2010 ACR/EULAR Criteria

Lena B. Nordberg¹, Siri Lillegraven¹, Elisabeth Lie¹, Anna-Birgitte Aga², Inge C Olsen², Hilde Berner Hammer³, Till Uhlig¹, Désirée van der Heijde⁴, Tore K. Kvien¹, Espen A. Haavardsholm¹ and the ARCTIC Study Group, ¹Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ²Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ³Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ⁴Dept. of Rheumatology, Leiden University Medical Center, Leiden, Netherlands

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: ACPA, Rheumatoid Factor and rheumatoid arthritis (RA)

Session Information

Date: Monday, November 9, 2015

Title: Epidemiology and Public Health Poster II: Pathogenesis and Treatment of Systemic Inflammatory Diseases

Session Type: ACR Poster Session B

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

Background/Purpose: The development of the 2010 ACR/EULAR classification criteria
for rheumatoid arthritis (RA) has led to a redefinition of the patient
population, including classification of seropositive versus seronegative
patients. Studies have yielded conflicting results on whether seropositive and seronegative RA represent
different disease entities.

Our aim was
to compare the disease characteristics of seropositive and seronegative
DMARD-naïve early RA patients classified
according to the 2010 ACR/EULAR
criteria.

Methods: RA patients who fulfilled the 2010 ACR/ EULAR classification
criteria were recruited at 11 rheumatology centers between 2010 and 2013. All
patients had symptom duration (from first swollen
joint) <2 years, and were DMARD naïve with indication for DMARD
treatment.

Patients
were stratified as seropositive (rheumatoid factor (RF)+,
anti-citrullinated peptide antibody (ACPA)+, or both) or seronegative
(both RF– and ACPA-) and
disease characteristics were compared across the groups using t-test or Mann-Whitney
U test as appropriate.

Results: A total of 237 patients were included with mean
(SD) age 51.5 (13.7) years, median [25-75 percentiles] disease duration 5.7 [2.8-10.2] months and
61.6% female gender. Thirty-five patients (14.8%) were seronegative.

The seronegative patients were older (mean age 56.9 yrs) than seropositive patients (50.5 yrs,
p=0.01), while gender distribution was similar. 43% of the seronegative
patients and 31% of the seropositive patients did not fulfill the 1987 ACR criteria for RA (p=0.17). Ultrasonography (US) scores,
number of swollen joints, DAS44 and Physician Global were significantly higher
in seronegative subjects compared to seropositive.
However, Richie articular index and patient reported outcome measures were
similar between groups.

	Seronegative RA n=35	Seropositive RA n=202	p
Disease duration¹, months	4.5 [2.5-10.5]	6.0 [3.0-10.0]	0.37
DAS^{2, 4}	3.9 (1.1)	3.4 (1.1)	0.02
PD score^{1, 3}	14 [7-29]	6 [2-12]	<0.001
GS score^{1, 3}	36 [21-52]	16 [10-24]	<0.001
Tot US score^{1, 3}	62 [34-70]	22 [14-36]	<0.001
SJC¹	18 [11-25]	8 [4-13]	<0.001
CRP¹, mg/L	9 [5-34]	7 [3-18]	0.15
ESR¹, mm/hr	15 [10-30]	20 [12-32]	0.40
Ritchie Articular Index¹	8 [3-16]	7 [4-12.5]	0.54
Physician Global², mm	52.1 (20.9)	38.2 (20.0)	<0.001
Patient Global², mm	52.1 (27.3)	49.2 (23.7)	0.53
EQ-5D¹	0.59 [0.06-0.73]	0.66 [0.23-0.72]	0.22
Pain VAS², mm	47.7 (27.0)	47.7 (23.5)	>0.99
Fatigue VAS², mm	41.6 (30.1)	40.0 (28.8)	0.78
RAID score²	4.9 (2.4)	4.4 (2.1)	0.21
¹Median [25-75 percentiles]. ²Mean(SD). ³US examinations were performed by experienced sonographers using a validated gray-scale (GS) and power-Doppler (PD) semi-quantitative scoring system with ranges 0-3 for GS and PD in 32 joints. ⁴Original DAS-ESR based on 44-SJC and Ritchie articular index.

Conclusion: In this cohort of DMARD
naïve early RA patients classified according to
the 2010 ACR/ EULAR
criteria, only 15% of patients were seronegative. We
found that the seronegative patients had higher
disease activity, assessed both clinically and by US, than seropositive
patients. This may in part be due to the strong weighting of RF and ACPA status in the 2010
criteria, requiring seronegative patients to have involvement
of many joints, and thus high disease activity, to fulfill the criteria.

Disclosure: L. B. Nordberg, None; S. Lillegraven, None; E. Lie, None; A. B. Aga, None; I. C. Olsen, None; H. B. Hammer, None; T. Uhlig, None; D. van der Heijde, None; T. K. Kvien, None; E. A. Haavardsholm, AbbVie, 2,Pfizer Inc, 2,MSD, 2,Roche Pharmaceuticals, 2,UCB, 2.

To cite this abstract in AMA style:

Nordberg LB, Lillegraven S, Lie E, Aga AB, Olsen IC, Hammer HB, Uhlig T, van der Heijde D, Kvien TK, Haavardsholm EA. The Clinical and Ultrasonographic Presentation of Seronegative RA Is More Severe Compared to Seropositive RA in an Inception Cohort of DMARD-Naïve Patients Classified According to the 2010 ACR/EULAR Criteria [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-clinical-and-ultrasonographic-presentation-of-seronegative-ra-is-more-severe-compared-to-seropositive-ra-in-an-inception-cohort-of-dmard-naive-patients-classified-according-to-the-2010-acreular-c/. Accessed .

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