SAT0084 IDENTIFICATION OF POOR PROGNOSTIC JOINT LOCATIONS IN AN EARLY, RAPIDLY PROGRESSING RA COHORT: A POST HOC ANALYSIS OF THE AGREE STUDY
Authors: Patrick Durez, Rene Westhovens, Yedid Elbez, Sofie Robert, Harris A. Ahmad
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Early RA patients (pts) often present with different areas of joint involvement, but limited data exist to identify which specific joint locations may be indicative of greater disease severity<sup>1</sup>. <h3>Objectives</h3> This analysis investigated the baseline (BL) prevalence of swelling and erosions in individual joint locations and their possible association with disease characteristics and prognostic factors in a unique cohort of early erosive RA patients using the AGREE study population. <h3>Methods</h3> In this post-hoc analysis of the Phase III AGREE study where methotrexate (MTX) naïve RF and/or ACPA seropositive pts with early (≤2 years [yrs]) erosive RA were treated with abatacept (ABA) plus MTX (n=256) or MTX (n=253)<sup>2</sup>, prevalence of BL swollen joint status (present, absent) was analysed for 6 large and 14 small joint locations: respectively wrists, elbows, shoulders, jaw, knees, ankles and MCP1-5, PIP2-5 and MTP1-5. Similarly, prevalence of BL erosive joint status was analysed for wrist, MCP1-5, PIP2-5 and MTP1-5. The association between BL disease characteristics and BL swelling or erosions was investigated for the individual joints. <h3>Results</h3> In this cohort of early, seropositive erosive RA (n=509), BL swelling was most frequently observed in the wrist (91.90%) and MCP2 joint (90.1%), whereas BL erosion was most frequently observed in the MTP5 joint (43.5%) (Table 1). BL swelling in the knee, jaw, wrist and elbow was highly associated (p&lt;0.001) with higher tender and swollen joint counts, higher DAS28 (CRP) and higher SDAI and CDAI. As expected, patients with BL presence of erosions had a higher total Genant-modified Sharp score (TSS) whatever the joint location. Overall, men seem more prone for erosions, and this is seen in all joint locations, except for the wrist. Moreover, in this already highly seropositive cohort, patients with BL erosions were more ACPA, but not RF, positive for all evaluated joints of the feet. BL swelling does not seem to be associated with erosive status, neither in the individual joint nor in the TSS, except for the MCP2 joint (erosion positivity was 21% and 4% and TSS was 7.4 [9.5] and 4.7 [5.6] in swollen and non-swollen MCP2 joints respectively). <h3>Conclusion</h3> In this cohort of early, seropositive erosive RA, swelling in the knee, jaw, wrist and elbow seems to be associated with the poorest prognosis, whereas BL MCP2 swelling seems to be associated with joint damage. While the data require further validation, a difference in joint location presentation may identify patients for an intensive treatment or a personalized treatment approach. <h3>References</h3> [1] Bergstra SA, et al. RMD Open2017;3:e000568. [2] Westhovens, et al. Ann Rheum Dis2009;68:1870–7. <h3>Disclosure of Interests</h3> Patrick Durez Speakers bureau: Bristol-Myers Squibb, Eli Lilly, Sanofi, Celltrion, Rene Westhovens Grant/research support from: Bristol-Myers Squibb, Consultant for: Celltrion, Galapagos-Gilead, Yedid Elbez Employee of: Employee of Excelya which received funding from Bristol-Myers Squibb as contract research organization., Sofie Robert Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Harris A Ahmad Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb