THU0141 SEVERELY DESTRUCTIVE UNILATERAL WRIST ARTHRITIS AS A RARE MANIFESTATION IN PATIENTS WITH RHEUMATOID ARTHRITIS – ANALYSIS OF CLINICAL AND IMAGING FEATURES AT A SINGLE CENTER
Authors: Viktor Korendovych, Radovan Vasko, Elena Nikiphorou, Jan-Gerd Rademacher, Gerhard A Müller, Peter Korsten
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rheumatoid arthritis (RA) is characterized by symmetrical involvement of small and large joints. New treatment modalities have not only allowed to achieve clinical remission or low disease activity, but also to halt the radiographic progression of joint destruction. In some patients, the disease progresses and leads to joint destruction despite treatment with disease-modifying antirheumatic drugs (DMARDs). Occasionally, wrist arthritis leads to severe destruction of carpal bones with ankyloses, so-called "os carpale". Severely destructive wrist arthritis in an asymmetrical, unilateral pattern has only rarely been reported in the literature and has not been systematically assessed (1). A severely destructive yet often symmetrical arthritis has been described in seronegative RA patients (2). <h3>Objectives</h3> To systematically analyze the presence of severely destructive unilateral wrist arthritis in a single-center, seropositive RA population and to identify risk factors for its development. <h3>Methods</h3> This is a single-center retrospective cohort study using routine clinical data. We performed a database search of our RA population for the presence of rheumatoid factor (RF) and/or anti-CCP antibodies (ACPA) from 2011 to 2017. Radiographs were assessed independently by two investigators for the presence of severely destructive unilateral wrist arthritis. Discrepancies were resolved by discussion. Epidemiological data including age, gender, disease duration, occupation, dexterity and smoking status were recorded. Patients with psoriasis, a family history of psoriasis or posttraumatic osteoarthritis were excluded. Past and current treatments were recorded. Conventional radiographs of the hands were scored using the modified Sharp score, magnetic resonance images were examined if available. <h3>Results</h3> We identified 1247 patients with either positive RF, ACPA, or both. After exclusion of non-RA diagnoses and radiograph review, 17 eligible patients were included in the study. Of these, 7 were excluded because of incomplete clinical data. All of the remaining ten patients were female (100%). Median age was 58.1 years (33-70), median disease duration was 15.5 years (1-22). Seven patients were right-handed, one was left-handed, in two patients, dexterity was not known. Six patients were smokers, two patients were non-smokers, in two patients, smoking status was not known. Median ACPA levels were 134,6 IU/ml (normal range &lt;5), median RF 54.2 IU/mL (NR &lt;16). All but two patients were positive for both antibodies; in three patients, ACPA were only mildly elevated (6, 11, and 14, respectively). 6/8 (75%) patients with severe destruction were smokers. In 5/7 (71.4%) right-handed patients, destruction occurred in the dominant wrist, whereas in 2/7 (28.5%) right-handed patients, destruction occurred in the non-dominant wrist. Patients received a mean number of 4.7 DMARDs. <h3>Conclusion</h3> Severely destructive unilateral wrist arthritis represents a rare phenotype of RA. In our cohort, this type of joint involvement was only present in women, it occurred primarily in the dominant hand (75%), and in smokers (75%). The mean number of used DMARDs was very high. Further studies for assessing the prevalence of this entity, also in seronegative patients, are required. <h3>References</h3> [1] Cassone, et al. (2004), Clinical and Experimental Rheumatology [2] Nikiphorou, et al. (2016), BMC Musculoskeletal Disorders <h3>Disclosure of Interests</h3> Viktor Korendovych Consultant for: Novartis, Radovan Vasko Consultant for: Novartis, Speakers bureau: Lilly, Elena Nikiphorou: None declared, Jan-Gerd Rademacher: None declared, Gerhard A Müller Grant/research support from: Novartis Boehringer-Ingelheim, Consultant for: Lilly, PETER KORSTEN Grant/research support from: Novartis Boehringer-Ingelheim, Consultant for: Novartis <h3>Pfizer</h3> Lilly, Paid instructor for: Chugai, Speakers bureau: Novartis