THU0079 AUTOANTIBODY-NEGATIVE PATIENTS, THE CUT-OFF OF SIX POINTS ACCORDING TO THE 2010 ACR/EULAR CRITERIA FOR RHEUMATOID ARTHRITIS MAY MISS A POPULATION OF SEVERE, PERSISTENT POLYARTHRITIS
Authors: Silvia Grignaschi, Serena Bugatti, Francesca Benaglio, Garifallia Sakellariou, Antonio Manzo, Roberto Caporali, Carlomaurizio Montecucco
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> At the group level, the classification criteria for rheumatoid arthritis (RA) developed in 2010 identify patients earlier than the 1987 criteria. However, performance of the new criteria in subjects negative for rheumatoid factor (RF) and anti-citrullinated protein autoantibodies (ACPA) is object of debate [1, 2]. In these patients, classification may be missed despite severe joint and systemic inflammation. <h3>Objectives</h3> To evaluate disease characteristics and arthritis persistence in autoantibody-negative patients with early polyarthritis fulfilling only 5 of the 10 points of the 2010 classification criteria for RA. <h3>Methods</h3> We included early arthritis patients from our Early Arthritis Cohort with at least one clinically swollen joint, symptoms for less than 12 months, no other explanation of arthritis and naïve to glucocorticoids and disease modifying anti-rheumatic drugs (DMARDs) at presentation. At baseline, fulfillment of each specific domain of the 1987 and the 2010 criteria was recorded. RF and ACPA were centrally determined on baseline sera. RF- and ACPA-negative patients achieving a total score of 5 in the 2010 criteria were compared to patients fulfilling RA criteria for baseline characteristics and for arthritis persistence (28-joints disease activity score [DAS28] &gt;3.2) after 2 months of follow-up. <h3>Results</h3> Of the total population of 882 patients with new-onset inflammatory arthritis, comprehensive evaluation of the fulfillment of the 1987 and the 2010 criteria was available in 771 cases (87.4%). Of these, 476 (61.7%) were negative for both RF and ACPA. Among autoantibody-negative patients, 193 (40.5%) scored less than 6 points according to the 2010 criteria, with 82 (42.4%) scoring 5 points. 35.4% of these patients were captured by the 1987 criteria at baseline. Reasons for not fulfilling 1987 criteria in the remaining were morning stiffness &lt;60 min in the majority of the cases (62.3%). As expected, autoantibody-negative patients scoring 5 points had lower disease activity with respect to autoantibody-negative patients fulfilling RA criteria (Table 1). Rather, disease activity, pain and loss of function were comparable to those of autoantibody-positive early RA patients (Table 1). After 2 months of follow-up, 58.1% of autoantibody-negative patients scoring 5 points remained in moderate disease activity (DAS28 &gt;3.2). <h3>Conclusion</h3> In autoantibody-negative patients with new-onset arthritis scoring 5 of the 10 points of the 2010 criteria for RA classification, arthritis is equally severe and disabling compared to autoantibody-positive patients classified as RA from baseline. In the majority of these patients, arthritis persists in the short term. Prospective data are thus awaited in order to assess whether the cut point of the 2010 criteria needs to be lowered in autoantibody-negative inflammatory polyarthritis. <h3>References</h3> [1] Jung SJ, et al. Ann Rheum Dis 2012;71:1097-8 [2] Boeters DM, et al. Semin Arthritis Rheum 2017;47:170-174. <h3>Disclosure of Interests</h3> Silvia Grignaschi: 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