FRI0731 Assessing the risk of rapid radiologic progression in hungarian rheumatoid arthritis patients
Authors: G Szücs, J Gaál, P Géher, E Gömöri, A Kovács, L Kovács, K Nagy, E Posta, L Tamási, E Tόth, E Varga, A Domján, Z Szekanecz
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Prognosis of rheumatoid arthritis (RA) should be assessed early during the disease course. Rapid radiological progression (RRP) has been defined as a ≥% unit increase in van der Heijde-Sharp score within a year. The matrix risk model has been developed by Vastesaeger et al in 2009. This tool calculates RRP based on non-radiographic indicators such as baseline CRP, RF and swollen joint count. <h3>Objectives</h3> We wished to test the matrix prediction model int he very first Hungarian cohort study. <h3>Methods</h3> In this non-interventional, cross-sectional retrospective study carried out in 11 Hungarian arthritis centres, we assessed high risk (≥40%) of RRP in biologic-naive RA patients with active disease. In order to obtain a representative sample, patients were selected from each centre by a random technique. RRP was calculated according to the matrix model described by Vastesaeger et al. As a secondary endpoint, we compared methotrexate (MTX) responders vs non-responders with respect to RRP. <h3>Results</h3> We screened data of 1843 RA patients. Finally, data obtained from 1356 patients could be used for RRP prediction and MTX responsiveness. The mean age of patients was 55.5 years, 84.7% were women. The mean disease duration was 8.4 years. At the time of the assessment, mean CRP was 17.7 mg/l, RF was 139,3 IU/ml, mean DAS28 was 5.00 and mean swollen joint count was 6.56. High risk ((≥40%) of RRP could be determined in 18.2% of patients. Among continuous variables other than those used for calculation of RRP risk, RA patients with the risk of RRP≥40% (n=247) had significantly lower age than those with RRP&lt;40% (n=1109) (53.33±12.31 vs 56.02±13.50 years; p=0.001). With respect to binary variables, the risk of RRP≥40% was significantly associated with non-response to MTX (OR: 17.82), male gender (OR: 1.53), ACPA positivity (OR: 2.11), the presence of erosions (OR: 1.37) and current smoking (OR: 1.66). Binary logistic regression analysis revealed that MTX non-response (OR: 16.84), male gender (OR: 1.67) and ACPA positivity (OR: 2.18) were independent predictors of high-risk RRP (≥40%). With regards to MTX responsiveness, binary logistic regression analysis confirmed that both male gender (OR: 5.20) and the presence of erosions (OR: 7.98) were independent predictors of high RRP risk in the MTX responder subpopulation. <h3>Conclusions</h3> In the first bioloigc-naive Hungarian RA cohort assessed for RRP, RRP occurs in almost one-fifth of the patients. These patients differ from others in various clinical and serological parameters. RRP has also been associated with non-response to MTX. <h3>References</h3> Vastesaeger N, Xu S, Aletaha D, St Clair EW, Smolen JS. A pilot risk model for the prediction of rapid radiographic progression in rheumatoid arthritis. Rheumatology (Oxford). 2009 Sep;48(9):1114–21. <h3>Disclosure of Interest</h3> None declared