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THU0062 Prognosis of Early Rheumatoid Arthritis Patients with Erosive Disease at Baseline
  1. N. Konijn1,
  2. L. van Tuyl1,
  3. M. Boers1,2,
  4. D. den Uijl1,
  5. M. ter Wee1,2,
  6. P. Kerstens3,4,
  7. A. Voskuyl1,
  8. D. van Schaardenburg4,5,
  9. M. Nurmohamed1,4,
  10. W. Lems1,4
  1. 1Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center
  2. 2Epidemiology & Biostatistics, VU University Medical Center, Amsterdam
  3. 3Rheumatology, Westfriesgasthuis, Hoorn
  4. 4Rheumatology, Amsterdam Rheumatology and immunology Center, Reade
  5. 5Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center, Amsterdam, Netherlands

Abstract

Background In 2013, a new EULAR definition of erosive disease for use in the 2010 ACR/EULAR rheumatoid arthritis (RA) classification criteria was published [1]. We were interested in the characteristics of early RA patients with erosive disease according to this new definition, including their propensity to reach ACR/EULAR Boolean remission [2].

Objectives To characterize the clinical course of early RA patients with erosive disease participating in a clinical trial, at baseline and after a 4-year follow-up period.

Methods The presence of erosive disease was assessed at the baseline visit of early RA patients who were treated in the context of the COBRA-light trial [3,4]. After 52 weeks, treatment was continued without protocol. Erosive disease was defined as: “an erosion (defined as a cortical break) seen in at least three separate joints at any of the following sites: the proximal interphalangeal, the metacarpophalangeal, the wrist (counted as one joint) and the metatarsophalangeal joints on radiographs of both hands and feet” [1]. Radiographs were scored by two independent trained assessors according to the Sharp/van der Heijde (SHS) method. ACR/EULAR Boolean remission was assessed at 3, 6, 9 months; and 1, 1.5, 2 and 4 years after trial initiation.

Results Only 8 (5%) of the 162 trial patients had erosive disease at baseline; these were somewhat older than patients without erosive disease at baseline (p=0.10). No differences in rheumatoid factor and ACPA status were found between erosive and non-erosive patients at baseline. After the 52 weeks trial period, 43% COBRA vs. 42% COBRA-light patients used prednisolone for ≥90 days, 34% vs. 44% patients switched to other DMARDs, and 39% vs. 28% used biologicals during the follow-up period. After a mean follow-up period of 4 years (data of 149 patients available), patients with erosive disease reported significantly higher disease activity (p=0.04) and pain (p=0.03) than patients without erosive disease, and a trend for more functional limitations (p=0.05) (Table 1). Likewise, the physician reported significantly higher disease activity (p=0.03); and both the SHS at 4 year (p<0.01) as well as SHS progression since baseline were higher for patients with erosive disease than patients without erosive disease (p=0.09). None of the erosive patients reached Boolean remission at any visit during the 4-year follow up-period, whereas 45% of the non-erosive patients did (p=0.01).

Conclusions In this exploratory study of early RA, erosive disease at baseline appeared to be rare. However, such disease is associated with a poor prognosis: more active disease, no remission, and worse 4-year outcomes despite a treat-to-target regime aimed at clinical remission.

  1. Van der Heijde, ARD 2013,72:479–81,

  2. Felson, Arthritis Rheum 2011,63:573–86,

  3. Den Uyl, ARD 2014,73:1071–8;

  4. er Wee, ARD 2015,74:1233–40.

Disclosure of Interest N. Konijn: None declared, L. van Tuyl: None declared, M. Boers: None declared, D. den Uijl: None declared, M. ter Wee: None declared, P. Kerstens: None declared, A. Voskuyl: None declared, D. van Schaardenburg: None declared, M. Nurmohamed: None declared, W. Lems Grant/research support from: This study was supported by an unrestricted grant from Pfizer

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