Session Information
Title: Rheumatoid Arthritis - Clinical Aspects: Novel Biomarkers and Other Measurements of Disease Activity
Session Type: Abstract Submissions (ACR)
Background/Purpose: The impact of missing ACPA in early inflammatory arthritis patients was studied to determine if failure to perform ACPA testing could cause a care gap.
Methods: 2191 patients recruited to CATCH were allocated to 3 groups: 1. seropositive (rheumatoid factor positive (RF+) and/or ACPA+), 2. seronegative (RF- /ACPA-) and 3. missing ACPA (RF negative [RF-]). Analyses were adjusted for age, sex, symptom duration, and smoking status if p<0.1. Data were also imputed to determine effect on results. One-third of ACPA were missing as this test is not reimbursed in all jurisdictions.
Results: More seropositive patients fulfilled 2010 ACR/EULAR RA criteria. Group 3 was slightly older, less: % female, symptom duration, and smoking. At 3 months, group 3 was treated with less DMARDs and methotrexate (P<0.00002), but there were no significant differences in DAS28, HAQ-DI, proportion receiving corticosteroids, or physician/patient global assessments. See table for full results.
Conclusion:
Patients with missing ACPAs were less likely to fulfill RA criteria and were treated differently with fewer medications but had similar outcomes at three months. Cost-effectiveness of ensuring ACPA testing availability in suspected RA is unknown. Imputed data did not alter results. There could be a care gap in the unknown ACPA group who were RF negative, but there were no significant differences in DAS28, 3 month change in DAS28, or HAQ-DI despite less treatment. We cannot determine whether performing ACPA in RF positive suspected ERA adds value as we combined the seropositive group into any seropositive result. The cost effectiveness of performing ACPA in RF negative patients could be debated if early RA is already suspected.
|
|
Total |
Seropositive |
Seronegative |
Missing anti-CCP, RF neg |
p-value |
|
Number of Patients (%) Baseline 3 months |
2191 1743 |
1276 (58.2) 1062 (60.9) |
497 (22.7) 359 (20.6) |
225 (10.3) 171 (9.8) |
N/A |
|
Age, mean ± SEM |
53.04± 0.34 |
51.63 ± 0.44 |
54.04 ± 0.67 |
55.58 ± 0.80 |
0.000009*
|
|
Rheumatoid factor serology at baseline, no. (%) |
|
1110 (50.7)
|
813 (37.1) |
268 (12.2) |
N/A |
|
Anti-CCP serology at baseline, no. (%) |
|
736 (33.6)
|
724 (33.0) |
731 (33.4) |
N/A |
|
Female, no. (%) |
1445 (72.6) |
958 (75.5) |
336 (67.6) |
151 (67.4) |
0.0007* |
|
Symptom duration at baseline, mean ± SEM (months) |
6.04 ± 0.08 |
6.24 ± 0.11 |
5.89 ± 0.18 |
5.26 ±0.21 |
0.0008*
|
|
Swollen joint count (ACR 28), mean ± SEM Baseline 3 months |
7.23 ± 0.14 3.46 ±0.11 |
7.05 ± 0.17 3.44 ± 0.14 |
7.44 ± 0.30 3.51 ± 0.21 |
7.74 ± 0.38 3.42 ± 0.25 |
0.19 0.95 |
|
DAS28, mean ± SEM Baseline 3 months |
4.89 ± 0.04 3.55 ± 0.04 |
4.92 ± 0.05 3.51 ± 0.05 |
4.81 ±0.07 3.60 ± 0.09 |
4.90 ± 0.10 3.70 ± 0.13 |
0.45 0.33 |
|
Change in DAS28 over 3 months, mean ± SEM |
-1.35 ± 0.05 |
-1.38± 0.05 |
-1.21 ± 0.10 |
-1.41 ± 0.15 |
0.29 |
|
Proportion in DAS28 remission at 3 months, no. (%) |
343 (28.2) |
248 (29.8) |
62 (24.3) |
33 (25.2) |
0.17 |
|
HAQ-DI Baseline 3 months |
1.00 ± 0.02 0.63 ± 0.16 |
1.01 ± 0.02 0.61 ± 0.02 |
0.98 ± 0.03 0.69 ± 0.04 |
0.97 ± 0.05 0.67 ± 0.05 |
0.57 0.12 |
|
Meets 2010 ACR/EULAR RA Classification Criteria no. (%)
|
1569 (78.8) |
1138 (89.7) |
293 (59.0) |
138 (61.6) |
0.000001* |
|
On Methotrexate, no. (%) Baseline 3 months |
1296 (64.9) 1194 (75.0) |
889 (69.7) 830 (78.2) |
283 (56.9) 250 (69.6) |
124 (55.1) 114 (66.7) |
0.000001* 0.0002* |
|
Number of DMARDs, mean ± SEM Baseline 3 months |
1.31± 0.02 1.60 ± 0.02 |
1.41 ± 0.02 1.67 ± 0.03 |
1.17 ± 0.04 1.51 ± 0.05 |
1.05 ± 0.05 1.36 ± 0.06 |
0.000001* 0.00002* |
|
On corticosteroid, no. (%) Baseline 3 months |
966 (48.3) 559 (35.1) |
614 (48.1) 370 (34.8) |
234 (47.1) 133 (37.0) |
118 (52.4) 56 (32.7) |
0.40 0.59 |
Disclosure:
J. Shu,
None;
V. P. Bykerk,
None;
G. Boire,
None;
C. A. Hitchon,
None;
J. C. Thorne,
Abbvie,
2,
Amgen,
2,
Celgene,
2,
Centocor, Inc.,
2,
Novartis Pharmaceutical Corporation,
2,
Pfizer Inc,
2,
Abbvie,
5,
Amgen,
5,
Celgene,
5,
Centocor, Inc.,
5,
Genzyme Corporation,
5,
Janssen Prmaceutical Products,
5,
Pfizer Inc,
5;
D. Tin,
None;
E. C. Keystone,
Abbott Laboratories,
2,
Amgen Canada,
2,
Astrazeneca Pharmaceuticals LP,
2,
Bristo-Myers Squibb,
2,
F. Hoffman La-Roche Inc.,
2,
Janssen Pharmaceutica Product, L.P.,
2,
Eli Lilly and Company,
2,
Novartis Pharmaceutical Corporation,
2,
Pfizer Inc,
2,
Sanofi-Aventis Pharmaceutical,
2,
Abbott Laboratories,
5,
AstraZeneca,
5,
Biotest,
5,
Bristol-Myers Squibb,
5,
F. Hoffman-La Roche Inc.,
5,
Genentech and Biogen IDEC Inc.,
5,
Janssen Pharmaceutica Product, L.P.,
5,
Eli Lilly and Company,
5,
Merck Pharmaceuticals,
5,
Pfizer Inc,
5,
Abbott Laboratories,
8,
AstraZeneca,
8,
Bristol-Myers Squibb,
8,
F. Hoffman La-Roche Inc.,
8,
Janssen Pharmaceutica Product, L.P.,
8,
Pfizer Inc,
8,
UCB,
8,
Amgen,
8;
B. Haraoui,
AbbVie,
2,
AbbVie,
5,
Amgen,
2,
Amgen,
5,
Bristol-Myers Squibb,
2,
Bristol-Myers Squibb,
5,
Janssen Pharmaceutica Product, L.P.,
2,
Janssen Pharmaceutica Product, L.P.,
5,
Pfizer Inc,
2,
Pfizer Inc,
5,
Roche Pharmaceuticals,
2,
Roche Pharmaceuticals,
5,
UCB,
2,
UCB,
5;
J. E. Pope,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-missing-anti-citrullinated-protein-antibody-acpa-on-outcomes-in-early-rheumatoid-arthritis-from-the-canadian-early-arthritis-cohort/