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Abstract Number: 459

The Effects of Erythrocytes and Platelets on Disease Activity in Patients with RA – ANSWER Longitudinal Cohort Study –

Akira Onishi1, Kengo Akashi 1, Sadao Jinno 2, Yonsu Son 3, Hideki Amuro 3, Toru Hirano 4, Yuichi Maeda 5, Motomu Hashimoto 6, Wataru Yamamoto 6, Kosaku Murakami 6, Ryota Hara 7, Masanori Katayama 8, Tohru Takeuchi 9, Takuya Kotani 9, Jun Saegusa 1 and Akio Morinobu 1, 1Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan, 2Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Osaka, Japan, 3First Department of Internal Medicine, Kansai Medical University, Osaka, Japan, 4Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan, 5Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan, 6Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan, 7The Center for Rheumatic Disease, Department of Orthopedic Surgery, Nara Medical University, Nara, Japan, 8Department of Rheumatology, Osaka Red Cross Hospital, Osaka, Japan, 9Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: platelets, prognostic factors and activity score, Rheumatoid arthritis (RA)

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Session Information

Date: Sunday, November 10, 2019

Title: RA – Diagnosis, Manifestations, & Outcomes Poster I: Risk Factors, Predictors, & Prognosis

Session Type: Poster Session (Sunday)

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

Background/Purpose: Experimental models suggested both erythrocytes and platelets activated immune cells and enhanced inflammation in inflammatory arthritis. Although previous cross-sectional studies showed the form and number of erythrocytes and platelets were associated with disease activity, the cross-sectional design cannot assess the causal relationship between erythrocytes/platelets and disease activity. Other limitations include no adjustment with confounding factors and small sample size. The objective of this multi-center longitudinal large cohort study is, therefore, to identify the effects of erythrocytes and platelets on disease activity in patients with RA.

Methods: Hemoglobin concentrations, mean corpuscular volume (MCV), red blood cell distribution width (RDW), platelet counts, and mean platelet volume (MPV) were measured as exposures. Disease activity was assessed using clinical disease activity index (CDAI) for primary outcome. Considering the estimation of effects of time-varying exposures and clustering effects by individual, linear mixed-effect models were used to examine the association between the indices of erythrocytes and platelets on the previous visit and disease activity on the next visit. The indices of erythrocytes and platelets, and disease activity were used as time-dependent variables while participant identification number and time from baseline were included as random factors. Age, sex, disease duration, RF, ACPA, prednisolone, and DMARDs were included as covariates. Sensitivity analyses were also conducted based on secondary outcomes of DAS28-CRP and simplified disease activity index (SDAI).

Results: A total of 63913 samples (median sampling interval: 66.2 days) from 3973 patients was included. The median age at baseline was 63.0 years with 78.3 % of women and mean disease activity were moderate (CDAI:10.9). Regarding erythrocytes, the next disease activity was significantly higher in patients with lower hemoglobin concentrations (-0.53/mg/dL, P < 0.001), MCV (-1.18/fL, P < 0.001), and RDW (-0.09/fL, P < 0.001) on the previous visit after adjusting by potential confounding factors. For platelets, higher platelet counts and lower MPV were associated with the next higher disease activity (0.20/μL, P < 0.001 and -0.55/fL, P < 0.001, respectively). These results were similar using DAS28-CRP and SDAI.

Conclusion: These results suggest the number and form of erythrocytes and platelets capture disease activity that remain unmeasured by established disease activity measures in RA. These may also support erythrocytes and platelets influence immune and inflammatory processes in patients with RA as well as the established opposite causal relationship.


Disclosure: A. Onishi, None; K. Akashi, None; S. Jinno, None; Y. Son, None; H. Amuro, None; T. Hirano, None; Y. Maeda, Bristol-Myers Squibb Company, 8, Chugai Pharmaceutical Co. Ltd, 8, Eli Lily, 8, Mitsubishi-Tanabe, 8, Pfizer, 8; M. Hashimoto, Astellas, 8, Ayum, 9, Brystol-Meyers, 8, Chugai, 9, Tanabe-Mitsubishi, 8, 9, UCB Japan, 9; W. Yamamoto, None; K. Murakami, Astellas Pharma Inc., 8, Bristol Myers Squibb,, 8, Chugai Pharmaceutical Co. Ltd., 8, Daiichi Sankyo Co. Ltd., 8, Eisai Co. Ltd, 8, Mitsubishi Tanabe Pharma Corporation, 8, Pfizer Inc, 8, UCB Japan Co. Ltd, 8; R. Hara, None; M. Katayama, None; T. Takeuchi, AbbVie, 8, AbbVie GK., 8, Asahi Kasei, 8, Astellas, 8, Astellas Pharma, 8, 9, AYUMI Pharmaceutical Co, 8, AYUMI Pharmaceutical Co., 9, Bristol Myers Squibb,, 8, Bristol-Myers, 8, Chugai Pharmaceutical Co. Ltd, 2, 8, 9, Daiichi Sankyo Co. Ltd, 8, Daiichi Sankyo Co. Ltd., 8, Eisai C o., Ltd., 8, 9, Eisai Co., Ltd, 8, Mitsubishi Tanabe Pharma Corporation, 8, 9, Takeda Pharmaceutical Company, 8, Takeda Pharmaceutical Company Limited, 8, 9; T. Kotani, None; J. Saegusa, None; A. Morinobu, None.

To cite this abstract in AMA style:

Onishi A, Akashi K, Jinno S, Son Y, Amuro H, Hirano T, Maeda Y, Hashimoto M, Yamamoto W, Murakami K, Hara R, Katayama M, Takeuchi T, Kotani T, Saegusa J, Morinobu A. The Effects of Erythrocytes and Platelets on Disease Activity in Patients with RA – ANSWER Longitudinal Cohort Study – [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/the-effects-of-erythrocytes-and-platelets-on-disease-activity-in-patients-with-ra-answer-longitudinal-cohort-study/. Accessed .
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