FRI0145 FACTORS ASSOCIATED WITH NEAR REMISSION DIFFER BETWEEN AUTOANTIBODY-POSITIVE AND -NEGATIVE PATIENTS WITH EARLY RHEUMATOID ARTHRITIS TREATED WITH CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
Authors: Ludovico De Stefano, Serena Bugatti, Francesca Benaglio, Garifallia Sakellariou, Antonio Manzo, Roberto Caporali, Carlomaurizio Montecucco
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Disease remission is recommended as the treatment target in patients with early rheumatoid arthritis (RA). According to the criterion, the proportion of patients classified as in remission considerably varies, with the Boolean-based definition being the most restrictive [1]. A considerable proportion of patients with established RA misses Boolean remission solely because of one of the 4 criteria (near remission) [2]. The frequency and the limiting variables to Boolean remission in real-life cohorts of patients with early RA are however unknown. <h3>Objectives:</h3> To assess the frequency and the limiting factors for fulfilling Boolean remission in early RA patients treated with csDMARDs according to a treat-to-target strategy. <h3>Methods:</h3> The study population consisted of 578 early RA patients (&lt;12 months of symptoms) consecutively recruited at our Early Arthritis Clinic, treatment-naïve at inclusion and prospectively followed-up upon initiation of therapy with methotrexate (MTX) aimed at the achievement of low disease activity (28-joints disease activity score [DAS28] ≤3.2). After 6 months of treatment, patients were classified as in remission or near remission according to the Boolean criterion as follows: (i) remission – swollen joint count (SJC28), tender joint count (TJC28), C-reactive protein (CRP) and patient global assessment of disease activity (PGA) all ≤1; (ii) near remission – just 3 of the 4 core items. Patients characteristics between remission and near remission were compared, and reasons for missing Boolean remission were analysed in relation to disease variables. <h3>Results:</h3> Complete follow-up data after 6 months of treatment were available for 89.3% of the patients. Disease remission was achieved in 25.6% of the cases according to the DAS28, 16.7% according to the simplified disease activity index (SDAI) and 11.6% according to the Boolean criterion. One-hundred and thirty-three patients (25.8%) failed to reach Boolean remission solely because of one of the 4 criteria. Of these, 45.9% were in DAS28 remission and 22.6% in SDAI remission. No differences in baseline demographic and clinical characteristics were found between patients in Boolean remission and patients in near remission. Use of prednisone co-medication and MTX starting dose were also comparable. Patients negative for both rheumatoid factor (RF) and anti-citrullinated protein autoantibodies (ACPA) were more frequently in near remission rather than in Boolean remission compared to autoantibody-positive patients (<b>Fig. 1A</b>). The missing criterion in near remission was SJC28 &gt;1 in 49% of the cases, PGA &gt;1 in 41%, and TJC28 &gt;1 or CRP &gt;1 mg/dl in the remaining 10%. Collectively, failure to achieve Boolean remission because of SJC28 &gt;1 was more common in RF and/or ACPA positive patients. Rather, autoantibody-negative patients more frequently missed remission due to PGA (<b>Fig. 1B</b>). <h3>Conclusion:</h3> In patients with early RA treated with csDMARDs, near remission is up to two times more frequent than Boolean remission. Collectively, autoantibody-negative patients more commonly miss complete remission solely because of one criterion compared to autoantibody-positive patients. Furthermore, in these patients, failure to achieve remission is mostly related to high PGA rather than to the persistence of joint inflammation. Altogether, these findings implicate that autoantibody-negative RA patients failing to achieve remission would require adjunctive tailored interventions rather than reinforcement of DMARD therapy. <h3>References:</h3> [1] Mack ME, et al. Arthritis Rheumatol 2017;69:518-28. [2] Studenic P, et al. Ann Rheum Dis 2012;71:1702-5. <h3>Disclosure of Interests:</h3> Ludovico De Stefano: None declared, Serena Bugatti Speakers bureau: Bristol-Myers Squibb, Celgene, Lilly, Novartis, Sanofi, Janssen, Francesca Benaglio: None declared, Garifallia Sakellariou: None declared, Antonio Manzo: None declared, Roberto Caporali Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Roche, Genzyme, Lilly, MSD, Pfizer, UCB, Carlomaurizio Montecucco Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Sanofi, Genzyme, Lilly, MSD, Pfizer, UCB