AB1258 THE 10 YEAREXPERIENCE OF IDENTIFYING AND MONITORING INDIVIDUALS AT RISK OF RA IN AN ARTHRITIS PREVENTION CLINIC
Authors: Laurence Duquenne, Kulveer Mankia, Jacqueline Nam, Leticia Garcia-Montoya, Peta Pentony, Andrea Dimatteo, Laura Hunt, Paul Emery
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Anti-cyclic citrullinated protein antibodies (anti-CCP) are highly specific for rheumatoid arthritis (RA) and may appear more than 10years before the disease. As the test has become more accessible, many patients without clinical synovitis are being globally tested. <h3>Objectives:</h3> We have developed in Leeds a prevention study clinic for referrals from individuals identified through our primary care research network alongside the patients from secondary care referrals, aiming for an early identification of inflammatory arthritis (IA)[1]. <h3>Methods:</h3> From June 2008 to December 2018, individuals from our primary care network with new musculo-squeletal symptoms were invited to be tested. All anti-CCP tests were performed centrally in our Rheumatology Department in Leeds (LIRMM), using a standard Anti-CCP2 assay (immunocap method, Phadia assay). Individuals from primary or secondary care who were tested positive for anti-CCP antibodies (CCP positive) were invited to Leeds and followed prospectively in a research, observational study until progression to IA. <h3>Results:</h3> As shown in figure 1, the number of patients referred to our study from either primary or secondary care has been increasing gradually. Over the last year, the overall referrals reached 2368 participants, 115 of them from secondary care and 2253 from primary care. Of the 901 CCP positive individuals, 479 met the inclusion criteria and accepted to participate to the study (Table 1). Actually, the mean follow-up time of the overall cohort is 98.5weeks (SD 105.55) with a cumulative time of follow-up of over 50 000 weeks. There is a female predominance of 72.1% and a mean age of 50.3 years (SD 13.51) at baseline. Of the 165 participants that have been withdrawn from the study, 134 developed IA after a mean time of 83.8 weeks (28.0% of the overall cohort). Currently, 353 anti-CCP positive patients are still being followed. Age and sex of the patients who progressed are similar to the ones still in the study (respectively p=0.798 and p=0.326). <h3>Conclusion:</h3> Leeds Teaching Hospital and LIRMM have now been following patients at risk of progressing to IA for more than 10 years. The steady increase in recruitment from both primary care and secondary care centres confers a viable base for recruitment. As prevention is a key aspect in global Health management, our study is a sustainable model for identifying at-risk subjects of progression, a necessary step towards prevention. This increase in overall referrals correlates with a need of recommendation regarding management of patients, especially those at high risk. <h3>References</h3> [1] Hunt, L. and P. Emery, Defining populations at risk of rheumatoid arthritis: the first steps to prevention. Nat Rev Rheumatol, 2014. 10(9): p. 521-30. <h3>Disclosure of Interests:</h3> Laurence Duquenne: None declared, Kulveer Mankia Grant/research support from: Research support from BMS and Lilly, Speakers bureau: Honoraria from Abbvie, UCB, Jacqueline Nam: None declared, Leticia Garcia-Montoya: None declared, Peta Pentony: None declared, Andrea DiMatteo: None declared, Laura Hunt: None declared, Paul Emery Grant/research support from: Pfizer, MSD, AbbVie, Bristol-Myers Squibb, Roche, Consultant for: Pfizer, MSD, AbbVie, Bristol-Myers Squibb, UCB, Roche, Novartis, Gilead,Samsung, Sandoz and Lilly