AB0316 ESTABLISHED SERONEGATIVE RHEUMATOID ARTHRITIS IS CONSIDERED A MILD FORM OF THE DISEASE, ALSO WILL IT BE THE SAME REGARD FOR VERY EARLY SERONEGATIVE RHEUMATOID ARTHRITIS?
Authors: Luis Daniel Fajardo Hermosillo
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Established Seronegative Rheumatoid Arthritis (ESNRA) is considered a mild form of the disease with a good prognosis and response to therapy compared with seropositive (SP) form [1]. Lately evidence indicates that seronegative (SN) form of arthritis in early stage is serious and should not be underestimated in terms of disease activity, response to therapy and radiographic damage [2,3,4]. At present, the influence of SN status of clinical course and treatment choice in very early stages, in other words less than 3 months from time at onset of disease, is still controversial [5]. <h3>Objectives</h3> To evaluate demographical, clinical and treatment differences between Very Early Seronegative Rheumatoid Arthritis (VESNRA) and Very Early Seropositive Rheumatoid Arthritis (VESPRA) in a Mexican cohort. <h3>Methods</h3> 64 patients with Very Early Rheumatoid Arthritis [(VERA), &lt; 3 months from time at onset of clinical manifestations] that fulfilled ACR/EULAR 2010 criteria (≥18 years) from a Mexican cohort recruited from 2015 to 2018 were examined and followed to 3, 6 and 12 months. Patients without presence of rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA) were considered SN. Demographic factors, clinical features, disease activity measured using DAS28, functional status evaluated using HAQ, comorbidities and pharmacologic treatments were examined for patients with VESNRA and VESPRA. Charlson's clinical co-morbidity index was used to analyze comorbidities. Chi-square and Student-t test was performed by univariate analysis and logistic regression was used by multivariate analysis, both were adjusted for age and gender. Statistical test were conducted at 5% level of significance. <h3>Results</h3> Of 64 patients with VERA 79% were women. The mean age [standard deviation (SD)] was 49.8 (13.5) years. The mean of time at onset of VERA (SD) was 77.8 (15.5) days. A total of 20 (31.2%) patients had VESNRA. In the univariable analyses VESNRA patients were more likely to have minor disease activity and better functional status during their follow-up to 3, 6 and 12 months [Table 1]. Moreover, VESNRA patients were more likely to present lesser work disability, lower comorbidities including fibromyalgia, to use fewer sulfasalazine, leflunomide, biologic agents and corticosteroids. As expected, the modified Charlson's comorbidity index score was lower in VESNRA patients through all their follow-up. In multivariable analyses less frequently use of corticosteroids (OR 0.68, 95% CI 0.42-0.88, p=&lt;0.001) remained significant in VESNRA patients <h3>Conclusion</h3> This study suggests that in very early stage of disease, SN form presents minor disease activity, better functional status, lower comorbidities, also require less aggressive therapy using biologic agents and corticosteroids than SP form in the course of one year. By these clinical and therapeutic differences should be considered VESNRA a mild form of the disease like as ESNRA. These observations must be confirmed in larger studies with further follow-up. <h3>References</h3> [1] Ann Rheum Dis2018;77:A936; (2) J Rheumatol 2014;41;2361-2369; (3) Ann Rheum Dis 2012;71:245–248; (4) Arthritis Res Ther 2014;16: R13; (5)Ann Rheum Dis2011;70:949-55 <h3>Disclosure of Interests</h3> None declared