FRI0046 Patients presenting with new musculoskeletal symptoms in the wrists, hands and feet enriches detection of anti-ccp antibodies in primary care – a national cohort study
Authors: P. Pentony, K. Karkalemis, J.L. Nam, K. Mankia, L. Hunt, E.M. Hensor, P. Emery
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Selecting patients with new non-specific musculoskeletal complaints can enrich the prevalence of anti-cyclic citrullinated peptide (anti-CCP) antibodies compared with the general population.<sup>1</sup> Patients with rheumatoid arthritis (RA) frequently present with involvement of the wrist, hands and feet. Patients with elderly onset RA have a higher frequency of polymyalgic onset. However, it is unknown if elderly patients with shoulder complaints are more likely to be CCP positive. <h3>Objectives</h3> To confirm the proportion of individuals with new-onset, non-specific MSK symptoms who were anti-CCP positive (CCP+) across a national cohort and investigate the initial presenting complaint of all individuals, as this may help determine whether there is a symptom complex that would prompt antibody testing. In addition to determine if the risk of being CCP +is increased in older patients presenting with shoulder symptoms. <h3>Methods</h3> Individuals aged ≥18 years with new musculoskeletal complaints without synovitis from primary care were recruited prospectively. Participants completed a questionnaire on baseline musculoskeletal symptoms and provided a blood sample for anti-CCP antibody (Phadia CCP-2) testing. CCP+individuals where invited to attend follow-up in the rheumatology department, Leeds. The association between CCP status, smoking and shared epitope status was also assessed. <h3>Results</h3> 4257 individuals were recruited, 2.9% (125/4257) were CCP+, a significantly higher proportion compared with the general population (1% (95% CI 2.4%&gt;3.5% p&lt;0.001)). Patients who presented with pain in the wrists, hands (RR 2.2 (1.5–2.9), p&lt;0.001) or feet (RR 1.72 (1.2–2.4), p&lt;0.001) had an increased relative risk of being CCP+. Patients who were older than 60 years who presented with shoulder symptoms (4.8% (7/146)) were no more likely to be CCP +than those who did not have shoulder symptoms (3.2% (31/1007), chi square p=0.313) and had the same prevalence of CCP +as those&lt;60 years (3.5% (13/370), chi square p=0.461). A significantly higher proportion of ever smokers were CCP+ (14.2% (48/337)) compared with never smokers (3.3% (64/1926); chi square p&lt;0.001). Ever smokers were also more likely than never smokers to be shared epitope positive in CCP +individuals (62.2% (23/37) cf 37.8% (14/37); p&lt;0.007). <h3>Conclusions</h3> Selecting individuals with new non-specific MSK symptoms without synovitis enriched the prevalence of anti-CCP positivity to 2.9%. Patients presenting with symptoms localising to the wrists, hands and feet were more likely to be CCP +which could prompt anti-CCP testing in these patients in primary care. Patients with shoulder complaints were no more likely to be CCP +than those without shoulder symptoms and had the same prevalence of CCP +as those&lt;60 years. <h3>Reference</h3> [1] Nam JL, et al., <i>Enriching case selection for imminent RA: the use of anti-CCP antibodies in individuals with new non-specific musculoskeletal symptoms – a cohort study</i>. Ann Rheum Dis, 2016;75(8):1452–6. <h3>Acknowledgements</h3> The authors would like to thank all the participating general practitioners and health professionals and the UK Clinical Research Network teams for the referrals from primary care to the study <h3>Disclosure of Interest</h3> None declared