Background In rheumatoid arthritis (RA), the patient global assessment (PGA) is influenced by a multitude of factors that may vary over time and in relation to certain disease characteristics [1]. The inclusion of the PGA in the definition of remission and the cut-offs that better guarantee good functional and structural outcomes remain therefore uncertain [2,3].

Objectives Aim of our study was to investigate the thresholds of the PGA capable of identifying sustained suppression of inflammation and functional integrity in patients with early RA in relation to the autoantibody status.

Methods Data were retrieved from a prospective monocentric cohort of 810 patients with early RA (<12 months of symptoms at inclusion) with an observation period of 24 months after treatment institution with methotrexate aimed at the achievement of low disease activity. Patients were evaluated for the achievement of Boolean 3-variable (3-v) remission (swollen joint count, tender joint count, and C-reactive protein all ≤1) at any time-point in the first 12 months. The thresholds of the PGA at the time of 3-v remission that best predicted persistence of 3-v remission after 6 months, and normal function (health Assessment Questionnaire, HAQ, ≤0.5) after 12 months were investigated through receiver operating curve (ROC) analyses in autoantibody-positive and –negative patients separately.

Results A total of 749/810 (92.5%) patients had follow-up data available until month 24. Of them, 390 (52.1%) achieved 3-v remission in the first year of observation after a median (IQR) of 6 (2-9) months. Autoantibody-positive patients showed a trend for earlier 3-v remission (adjusted HR [95% CI] 1.21 [0.99-1.48]). Among patients achieving 3-v remission, 193 (49.5%) maintained 3-v remission after 6 months, without significant differences in relation to the autoantibody status. Normal function after 12 months characterized slightly more autoantibody-positive than –negative patients (91.2% vs 83.3%, p=0.15). The best cut-off values of the PGA capable of predicting persistence of 3-v remission and normal function in autoantibody-positive patients were ≤9 (AUC 0.76) and ≤13 (AUC 0.73), respectively (Table 1). The corresponding thresholds in autoantibody-negative patients were ≤20 (AUC 0.75) and ≤21 (AUC 0.69).

Conclusion Increasing the threshold of the PGA to ≤20 in patients with early RA is associated with sustained suppression of inflammation and good functional outcomes in autoantibody-negative patients. In contrast, in autoantibody-positive patients, a stringent threshold of ≤10 remains optimal.

References

1. Bugatti S et al. Ann Rheum Dis 2022; doi: 10.1136/annrheumdis-2022-222436.
2. Studenic P et al. Ann Rheum Dis 2020; doi: 10.1136/annrheumdis-2019-216529.
3. Ferreira RJO et al. Ann Rheum Dis 2020; doi: 10.1136/annrheumdis-2020-217171.

Acknowledgements: NIL.

Disclosure of Interests Ludovico De Stefano: None declared, Bernardo D’Onofrio: None declared, Elena Marazzi: None declared, MIchele Di Lernia: None declared, Emanuele Cassione Bozzalla: None declared, Antonio Manzo: None declared, Carlomaurizio Montecucco Speakers bureau: AbbVie, Bristol Myers Squibb, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Janssen, Serena Bugatti Speakers bureau: AbbVie, Bristol Myers Squibb, Eli Lilly, Galapagos, Novartis, Pfizer.

Keywords: Rheumatoid arthritis, Autoantibodies, Patient reported outcomes

DOI: 10.1136/annrheumdis-2023-eular.4875