THU0108 REAL-WORLD RADIOGRAPHIC PROGRESSION IN RA WITH BIOLOGIC DMARDS
Authors: N. Pamplona Bueno de Andrade, P. Palominos, V. Hax, A. A. Gasparin, V. Cé Bressan, L. Guimarães Da Silveira, C. Brenol
Journal: Annals of the Rheumatic Diseases (2020)

Background: As structural damage is irreversible and strongly associated with functional disability 1 , it is an important outcome to be prevented in rheumatoid arthritis (RA). Acute phase markers, rheumatoid factor (RF) and anti-citrullinated protein (anti-CCP) positivity are important predictors of erosive disease 2 . Previous studies conducted in real life setting have divergent results regarding the role of disease activity in radiographic progression 3,4 . Objectives: To evaluate the impact of disease activity and biologic disease modifying anti-rheumatic drugs (bDMARDs) on radiographic progression of established RA in clinical practice in southern Brazilian public health system. Methods: Longitudinal retrospective study including patients with RA (1987 ACR criteria) treated with bDMARDs and followed from 2015 to 2019. Clinical and demographic data were collected at baseline. Radiographs of hands and feet were performed yearly. X-rays were scored according to the van der Heijde-modified total Sharp method (vdH-mTSS) in known chronological order. Clinical relevant radiographic progression (CRRP) was defined as an increase ≥3 units on the score per year5.Demographic, clinical, and radiographic characteristics of RA patients with or without relevant progression were compared with Fisher exact and Mann-Whitney test. Results: Seventy-five patients were included. The patients’ characteristics are shown in table 1. Twenty three (30%) patients presented CRRP at any time point of the follow up (figure 1). Mean DAS28-ESR at baseline was higher in patients who progressed radiographically, than those who did not progress (4.8±1.1 vs 3.5±1.1; p &lt; 0.001). No patient in remission at baseline presented with CRRP. Radiographic progression occurred in 15% of patients in low disease activity, 34% of patients in moderate disease activity and 57% of patients in high disease activity at baseline, depicting a linear relation between categories of disease activity and CRRP. RF, anti-CCP, disease duration, educational level, smoking status, total vdH-mTSS at baseline, number and duration of biologic DMARDs were not associated with CRRP. No single biologic DMARD was associated with worse radiological prognosis. Table 1. Baseline characteristics and bDMARD treatment during 5 years of follow up Characteristics N = 75 Age, yrs, mean ± SD 58.1 ± 10.1 Female, n (%) 65 (86.6) Disease duration, yrs, mean ± SD 16.2 ± 7.6 IgM RF positivity, n (%) 69 (92) Anti-CCP positivity, n (%) 27 (75) * DAS28-ESR, mean ± SD 4.2 ± 1.0 Educational level, n(%) Elementary school (≤ 8years) 49 (65) Intermediate school (9-12 years) 23 (30,6) University/college degree 3 (4) Smoking Current or former 31 (41.3) Never 44 (58,7) vdH-mTSS, median (IQR) 21 (5-53) Number of bDMARD, mean ± SD 2.4 ± 1.1 Duration of bDMARD, yrs, mean ± SD 7.4 ± 2.6 Methotrexate use, n, % 61 (81) Biologic DMARD 184** TNF inhibitors, n, % 106 (57.6) Tocilizumab, n, % 30 (16.3) Abatacept, n, % 25 (13.6) Rituximab, n, % 23 (12.5) RF rheumatoid fator anti-CCP anti-citrullinated protein bDMARD biologic disease-modifying anti-rheumatic drug ESR erythrocyte sedimentation rate DAS28 disease activity in 28 joints vdH-mTSS van der Heijde-modified total Sharp score IQR interquartile range *information available from 36 patients **all bDMARD treatments Conclusion: In contrast to controlled clinical trials, real-world studies have shown that patients with RA treated with bDMARD still develop radiological progression. We observed that despite prognostic factors, achievement of treatment target is the most important factor to prevent articular damage in RA. References: [1]Ann Rheum Dis 2012;71(6):836-44 [2]Rheumatology 2016;55:1053-1065 [3]Arthritis Res Ther 2019;21(1):237 [4]Medicine 2016;95(17) [5]Ann Rheum Dis 2005; 64(2): 179–182 Disclosure of Interests: Nicole Pamplona Bueno de Andrade: None declared, Penelope Palominos Grant/research support from: This work was sponsored by the regional society of rheumatology (Sociedade de Reumatologia do Rio Grande do Sul)., Vanessa Hax: None declared, Andrese Aline Gasparin: None declared, Vanessa Cé Bressan: None declared, Letícia Guimarães da Silveira: None declared, Claiton Brenol: None declared