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AB0012 In the elderly acpa-negative ra is more prevalent than acpa-positive ra while the composition of the acpa-response appears identical
  1. D Boeters1,
  2. L Mangnus1,
  3. S Ajeganova1,2,
  4. E Lindqvist3,
  5. B Svensson4,
  6. R Toes1,
  7. L Trouw1,
  8. T Huizinga1,
  9. F Berenbaum5,
  10. J Morel6,
  11. S Rantapää-Dahlqvist7,
  12. A van der Helm-van Mil1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
  2. 2Department of Medicine Huddinge, Karolinska Institutet, Stockholm
  3. 3Department of Clinical Sciences, Section of Rheumatology, Lund University and Skåne University hospital
  4. 4Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
  5. 5Department of Rheumatology, Sorbonne University, INSERM UMR_s938, DHU i2B, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, Paris
  6. 6Department of Rheumatology, Teaching hospital Lapeyronie and Montpellier University, Montpellier, France
  7. 7Department of Public Health and Clinical Medicine/Rheumatology, University Hospital, Umeå, Sweden


Background Rheumatoid arthritis (RA) consists of two syndromes, one autoantibody-positive and one autoantibody-negative. This multi-cohort study assessed the age of onset in relation to the presence of autoantibodies. The association with characteristics of the anti-citrullinated protein antibodies (ACPA)-response was also explored.

Objectives 1) determine the association between age of RA-onset and the presence of ACPA, rheumatoid factor (RF) and anti-carbamylated protein (anti-CarP) antibodies, 2) study if age of onset was associated with characteristics of the ACPA-response, 3) substantiate previously reported associations between age of onset and clinical characteristics.

Methods 3,321 1987-positive RA-patients included in the Leiden-EAC, BARFOT, ESPOIR, Umeå and Lund cohorts were studied at presentation on age of onset and the presence of ACPA, RF and anti-CarP antibodies. Logistic regression analyses were performed; effect sizes were summarized in inverse-weighted meta-analyses. Within ACPA-positive RA, ACPA-level was studied in all cohorts; ACPA-isotypes, ACPA-fine-specificity and ACPA-avidity index and clinical characteristics were studied in the Leiden-EAC.

Results From the age of fifty onwards, the proportion of ACPA-negative RA-patients increased in Dutch, Swedish and French cohorts. Similar observations were done for RF and anti-CarP. The composition of the ACPA-response did not change with increasing age of onset with respect to titer, isotype distribution, fine specificity and avidity index. With increasing age of onset RA-patients smoked less often, had higher acute phase reactants and more often a sub(acute) symptom onset.

Conclusions Data of five cohorts revealed that with higher age of onset ACPA-negative RA is more frequent than ACPA-positive RA, while characteristics of ACPA-positive RA as judged by the composition of the ACPA-response appeared not age-dependent. Although more biologic studies are needed to characterize the pathogenesis of ACPA-negative polyarthritis at older age, the present data can promote personalized treatment decisions in ACPA-negative patients in daily practice.

Disclosure of Interest None declared

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