POS1441 SYMPTOMS CHARACTERISTICS OF SEROPOSITIVE INDIVIDUALS AT-RISK FOR DEVELOPING RHEUMATOID ARTHRITIS ARE VERSATILE AND COMPARABLE TO THOSE IN PEOPLE WITH EARLY RHEUMATOID ARTHRITIS
Authors: P. Studenic, A. Circiumaru, D. Aletaha, K. Chatzidionysiou, A. Hensvold, A. Catrina
Journal: Annals of the Rheumatic Diseases (2021)

Background: The symptom burden of typical rheumatoid arthritis (RA) symptoms in those at risk for developing RA - positive for anti-citrullinated peptide antibodies (ACPA) and musculoskeletal complaints - has not been explored. Objectives: To evaluate patient-reported symptoms in individuals at-risk to develop RA in comparison to people with newly diagnosed, early seropositive RA. Methods: Two datasources from the region of Stockholm were used: The RISK RA cohort follows up ACPA positive individuals with arthralgia, but without signs of joint inflammation in a structured program over 3 years. The baseline visit of this cohort was used. Patients with early seropositive (ACPA and/or rheumatoid factor positive) RA (symptom duration of 12 months maximum) reported in the Swedish Rheumatology Quality Register (SRQ) at their closest visit to their diagnosis date before receiving DMARD treatment have been identified. At-risk individuals were matched 1:3 by sex and age using the nearest neighbour method utilizing Mahalanobis distance, corrected for sample bias and exact matches on sex. Effect estimates of being at-risk compared to early RA for pain, patient global (GH), fatigue (all visual analogue scales), health assessment questionnaire (HAQ), TJC28 and the EuroQol-5D (EQ5D; range: 0-1) have been derived. Propensity score matching was used as sensitivity analyses. Results: A total of 223 individuals at risk for developing RA were compared to 820 matched early RA patients. The summary of distribution of variables and effect estimates of differences between at-risk and early RA individuals are shown in the Figure 1. At-risk individuals show 24mm of lower pain scores than early RA. This difference is even less (-17mm, 95%CI: -24 to -11) when the estimate is additionally matched for the number of tender joints. The TJC28 was on average 5.4 joints lower than in early RA patients. People at-risk show 22mm lower GH scores (rate themselves better) and 17mm lower fatigue scores than early RA patients. Fatigue was scored highest (mean:35mm, 95%CI: 30 to 29) among the three VAS. HAQ was on average lower by 0.6 points in at-risk individuals and EQ5D showed 0.24 higher index-values, outlining a better health status. Still the mean EQ5D in at-risk individuals was only 0.74 (95%CI: 0.71 to 0.77), which is lower than average values of an age-matched general population (0.92 to 0.96). Sensitivity analyses revealed similar results. Figure 1. Boxplots of pain, global health, fatigue, TJC28, EQ5D and HAQ, separately displayed for people with early seropositive RA and individuals at-risk. Population effect estimates (all p&lt;0.001) comparing at-risk to early RA are provided for every pair, with 95% confidence interval in brackets. Conclusion: Not surprisingly, individuals at risk for RA report less symptom burden then early diagnosed RA patients. However, these differences only range around minimal clinically important differences and for fatigue even below, which stresses the need for medical attention and management strategies for symptomatic at-risk individuals. Acknowledgements: This study was supported through the New Horizon Fellowship and the FOREUM research fellowship grant and is part of the Innovative Medicines Initiative Joint Undertaking under grant agreement no 777357 (RTCure). Hensvold AH and Catrina IA contributed equally. Disclosure of Interests: None declared