Objectives To compare clinical and immunological characteristics in patients with undifferentiated connective tissue disease (UCTD) treated with hydroxychloroquine (HCQ) in a large academic clinical practice.
Methods This cross-sectional study included all patients diagnosed with UCTD according to the preliminary classification criteria (1), that seen at the Columbia University Lupus Clinic in New York, from January to December 2015. Clinical and immunological variables were ascertained by clinical evaluation and chart review. Chi squared tests were used to compare the following characteristic between treated and untreated patients: demographic characteristics, number of ACR criteria, SLICC criteria, individual symptoms and laboratory values.
Results Eighty-three patients were identified; 93% were female, mean age at diagnosis of 44 years ±14.9; 67% were Caucasian, 20% Hispanic and 11% Black/African American; median disease duration of 3.91 years ±5.35. The most prevalent symptoms that required medical attention were arthralgia (81%), arthritis (46%), Raynaud (41%), fatigue (32%) and sicca symptoms (30%). All patients had positive antinuclear antibody (ANA) titers, 87% had titers above 1:640, with speckled pattern in 71% of patients. Interestingly, 16% of the patients studied met SLICC SLE criteria. Half of the patients, 42 (51%) were treated with HCQ and 41 (49.3%) were not treated.
The patients treated with HCQ were more likely to meet SLICC criteria (10 vs. 3, respectively; p=0.03), have a history of arthralgia (38 vs. 29; p=0.02), arthritis (28 vs. 10; p=0.0001), and fatigue (25 vs. 14; p=0.02). A history of low complement was more prevalent in the treated group (12 vs. 3, p=0.01).
Conclusions Data from this single-center cohort of patients with UCTD show that patients treated with HCQ by their rheumatologist are more likely to have multiple clinical criteria and low complement compared to those that were not treated. These data suggest that rheumatologist treat pre-clinical autoimmunity in the setting of clinical symptoms. None of patients were treated based on serologies alone. Longitudinal studies are needed to evaluate the long-term impact of HCQ on outcomes in patients with UCTD.
Mosca M, Neri R, Bombardieri S. Undifferentiated connective tissue diseases (UCTD): a review of the literature and a proposal for preliminary classification criteria. Clin Exp Rheumatol 1999;17:615–20.
Disclosure of Interest None declared