Objectives To assess possible differences in the major outcome (disease remission) over time in anti-citrullinated peptide antibodies (ACPA) and rheumatoid factor (RF)-IgM seropositive and seronegative early rheumatoid arthritis (ERA) cohorts.
Methods A total of 265 ERA patients with a disease duration less than 12 months [154 (58.3%) seropositive for both ACPA and RF-IgM and 110 (41.7%) double seronegative] were enrolled in the study. ERA patients were naïve to DMARD therapy and fulfilled the 2010 American College of Rheumatology criteria for RA. At baseline, patients were treated with methotrexate (up to 20 mg weekly) and, when necessary, steroids at low dosage for three months; then a combination with a TNF blocker (adalimumab 40 mg every two weeks, or etanercept 50 mg weekly) was started if patients showed a severe disease activity, according to DAS value. At baseline and every 3 months demographic and immunological data and the ACR/EULAR core data set [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), swollen joint count (SJC), tender joint count (TJC), physician and patient global assessment, pain, health assessment questionnaire (HAQ)] were recorded. At each visit, clinical improvement and remission were evaluated according to DAS [1,2] and ACR/EULAR Boolean criteria .
Results At baseline, seropositive subjects were younger at diagnosis (p=0.02) and more smokers (p=0.001). There were no differences in gender, symptom duration, inflammatory parameters (ESR and CRP) and presence of erosions between seropositive and seronegative subjects. Seropositive patients showed a lower average of TJC (p=0.03) and SJC (p=0.01) compared with seronegative ones. Similar percentages of good-EULAR response and DAS-remission were seen over time between seropositive [Good-response (3 months: 54.6%; 6 months: 73.7% and 12 months: 78.3%) and DAS-remission (3 months: 36.1%; 6 months: 50.9% and 12 months: 57.4%)] and seronegative patients [Good-response (3 months: 59.5%, p=0.52; 6 months: 69.2%, p=0.50; 12 months: 73.8, p=0.47, respecvtively) and DAS-remission (3 months: 36.5%, p=0.96; 6 months: 46.2%, p=0.52; 12 months: 57.5%, p=0.99)]. The ACR/EULAR Boolean remission rate was higher in seropositive (6 months: 40.4%, 12 months: 45.2%) compared to seronegative patients (6 months: 23.4%, p=0.02; 12 months: 35.0%, p=0.15). Similar percentage of subjects started a combination therapy with a TNF blocker in the two cohorts.
Conclusions In our seropositive e seronegative ERA cohorts, the major outcome, i.e. disease remission, was similar when using a T2T algorythm. A deeper understanding of the biological basis of the two subsets of the disease is clearly the major missing point.
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Disclosure of Interest : None declared
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