AB0685 FACTORS ASSOCIATED WITH EROSIONS AND JOINT SPACE NARROWING IN EARLY RHEUMATOID ARTHRITIS
Authors: C. Turesson, T. Miegel, M. Hameed, G. Cagnotto, A. Eberhard
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> In rheumatoid arthritis (RA) progressive joint damage occurs in a subset of patients. Typical lesions are characterized as bone erosions due to local osteoclast activation, and joint space narrowing (JSN) due to reduced cartilage. Predictors of severe long term radiographic progression have been described, but there is limited information on drivers of early joint damage among patients with early diagnosis in recent years. <h3>Objectives:</h3> To investigate the relation between baseline characteristics and presence of erosions or JSN on radiographs of hands and feet of patients with early RA. <h3>Methods:</h3> In a retrospective study, consecutive patients diagnosed with RA and a reported symptom duration of &lt; 12 months at a single rheumatology center in 2012-2016 were included. All patients fulfilled the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism and/or the 1987 ACR classification criteria for RA. Clinical data were retrieved from structured reviews of the medical records. Reports from radiographs of the hands and the feet obtained between 3 months before and 6 months after the date of diagnosis were reviewed and classified as reporting presence vs absence of juxta-articular erosions or arthritis-related JSN. Reports describing JSN as likely due to osteoarthritis were considered negative for this outcome. Potential predictors of erosions or arthritis-related JSN were assessed in logistic regression models. <h3>Results:</h3> In a total of 367 included patients with early RA, radiographs from the relevant time period were available for 278. Among these, 70.5 % were females, the mean age at diagnosis was 59.1 years (standard deviation (SD) 15.4) and the mean duration of symptoms was 5.7 months (SD 3.2). Rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) were positive in 66.9 % and 70.5 %, respectively. High antibody levels (&gt;3 times the limit of normal) were found in 52.5 % for RF and 56.8 % for ACPA. The mean DAS28-CRP was 4.64 (SD 1.45). Erosions were reported in 49 patients (17.6 %) and JSN in 51 patients (18.3 %). A longer symptom duration was associated with the presence of erosions, and there was also a trend towards an association with RF, which reached significance in multivariate analysis (Table 1). Further analyses comparing individuals with high antibody levels (&gt;3 times the limit of normal) to those with lower levels or negative tests revealed a significant association with erosions for high-level RF (odds ratio (OR) 2.06; 95 % confidence interval (CI) 1.08-3.96), but not for high-level ACPA (OR 1.70; 95 % CI 0.87-3.26). For arthritis-related JSN, there were associations with longer symptom duration, higher age and with CRP or ESR in the highest quartile (Table 2). In multivariate analysis, longer symptom duration (OR 1.50 per SD; 95% CI 1.10-2.03) and high CRP (&gt;26.5 mg/l) (OR 3.34; 95% CI 1.29-8.62) were both associated with presence of arthritis-related JSN. <h3>Conclusion:</h3> Erosions and JSN are each reported in about 18% of patients with early RA. Patients with a longer duration of symptoms at RA diagnosis are more likely to have early erosions or arthritis-related JSN. There was also an association between RF and early erosions, which is compatible with previous studies. High levels of laboratory markers of inflammation were associated with arthritis-related JSN, suggesting that systemic inflammation plays a greater role for cartilage damage than for juxta-articular bone resorption in early RA. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Carl Turesson AbbVie, Boehringer-Ingelheim, Nordic Drugs, Novartis, Pfizer, Roche., Tom Miegel: None declared, Mohaned Hameed Novartis, Giovanni Cagnotto: None declared, Anna Eberhard: None declared.