AB0185 PHENOTYPES OF DRUG-FREE RHEUMATOID ARTHRITIS FLARE AND IMPACT OF RESIDUAL SUBCLINICAL ECOGRAPHIC JOINT INJURY IN ACPA POSITIVE AND ACPA NEGATIVE DISEASE

Autor: E. Bozzalla Cassione, S. Grignaschi, B. Xoxi, M. I. Greco, T. Luvaro, I. Mazzucchelli, S. Bugatti, C. Montecucco, A. Manzo
Rok vydání: 2022
Předmět:
Zdroj: Annals of the Rheumatic Diseases. 81:1222-1222
ISSN: 1468-2060
0003-4967
Popis: BackgroundThe mechanisms of flare across the pathogenic spectrum of RA remain unclear. To what extent RA flare reproduces the dynamics of disease onset or is primarily driven by new dynamics is not known. Furthermore, the hypothesis of a role for circulating auto-antibodies in determining different mechanism behind flare has never been challenged.ObjectivesTo evaluate whether RA flare after remission achievement reproduces the phenotype of onset or it is characterized by a different phenotype primarily driven by the pattern of residual joint injury after treatment, in ACPA positive and negative patients.Methods53 RA patients, in stable drug-free remission (DFR) after early csDMARDS introduction and displaying clinical flare across 60 months of follow-up were analysed for clinical, laboratory and ultrasound (US) characteristics at diagnosis, treatment discontinuation, and flare (DAS28- and/or physician-based flare). We compared the synovitis clinical phenotype (ACR 1987 criteria defined districts), PROs and the inflammatory status at disease flare versus onset. We then measured the impact of residual subclinical US joint injury (absence of objective synovitis and GS>1 and/or PD>0) at the time of drug discontinuation, on the synovitis clinical phenotype of flare. Finally, we explored differences in the outcomes in ACPA positive and negative RA.ResultsCohort characteristics are shown in Table 1. As inferred by paired analyses, no significant differences were observed between onset and flare concerning composite indices of disease activity, and subjective/semi-objective domains. However, flare appeared to be significantly less inflammatory in terms of CRP, ESR, SJC, morning stiffness and HAQ (p0.05).Table 1.Comparison between Onset and FlareOnset,median (IQR)Flare,median (IQR)Sex, female (%)34 (64)\Age at Symptoms onset (yrs)57 (43-65)\Diagnostic delay(months)3 (2-7)1.5 (1-2) *ESR (mm/h)20.0 (12.0-38.5)17 (9.00-27.0)§CRP (mg/dL)0.640 (0.307-2.11)0.370 (0.220-1.05) *§HAQ0.625 (0.375-1.13)0.438 (0.125-0.875)GH40.0 (26.5-50.0)40 (30.0-50.0)PGA50.0 (27.0-66.5)49 (20.0-70.0)EGA38.0 (27.0-60.0)40 (30.0-60.0)SJC/667 (4.00-10.0)4 (3.00-6.00) *§TJC/685 (2.00-10.0)5 (2.00-11.0)DAS28-ESR4.55 (3.29-5.36)3.98 (3.56-4.61)DAS28-CRP3.98 (3.08-4.88)3.83 (3.00-4.27)Morning Stiffness (minutes)60.0 (11.3-90.0)10 (1.00-30.0) *§Index: *significant compared to onset, § significant compared to onset considering only VERAConclusionRA flare in patients achieving DFR seems to be less severe in terms of inflammatory markers and synovitis recurrence, despite a similar degree of joint tenderness and patients’ perception compared to disease onset. The arthritis phenotype undergoes detectable changes more in ACPA positive than negative patients. The residual subclinical US joint damage seems to drive the localization of synovitis recurrence in ACPA negative more than positive patients, supporting the existence of pathologic differences in the process of disease reactivation in the two groups.Disclosure of InterestsNone declared
Databáze: OpenAIRE
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