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RISK RA: Certain ACPA antibodies, tenosynovitis predicted RA onset
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ATLANTA — The presence of tenosynovitis, along with an anti-filaggrin peptide, were associated with the development of rheumatoid arthritis in a cohort of participants who underwent anti-citrullinated protein antibody testing, according to a speaker at ACR/ARP 2019.
“Our hypothesis was that the development of seropositive rheumatoid arthritis starts with a complex interaction between genes and environment, leading to immune activation at mucosal sites, and altering immunity with the generation of antibodies that will then be present several years before disease onset,” Anca Catrina, MD, of the rheumatology unit at Karolinska University Hospital and Karolinska Institute in Stockholm, said in her presentation.
The group prospectively evaluated whether testing for ACPA and other antibodies would have utility in predicting ultrasound-detected arthritis. Eligible participants included individuals with a positive ACPA test who had been referred to the rheumatology clinic despite a lack of symptoms in the feet, hands or knees by clinical or ultrasound exam.
Participants were recruited between 2015 and 2016 and followed through January 2019. The researchers assessed patients for 13 specific ACPA reactivities, along with 92 inflammation-associated protein biomarkers.
The final analysis included 268 patients (80% women) with a median age of 48 years, according to Catrina.
Results showed that 75 participants developed arthritis during 2 years of follow-up, while 175 participants were free of arthritis at that time. The median follow-up duration was 19 months.
Results showed that the symptom duration was 11 months in those who developed arthritis at follow-up and 27 months in those who did not (P < .05). “The symptom duration was significantly shorter in those who developed arthritis,” Catrina said.
Another key finding was that rheumatoid factor positivity was observed in 53% of patients who developed arthritis and 25% of those who did not (P < .05).
Anti-CCP antibodies were observed in 100% of individuals in both the arthritis and nonarthritis groups.
Looking at multivariate analysis results, Catrina reported that 44% of patients who developed arthritis had tenosynovitis, compared with just 11% among those who did not (HR = 3.1; 95% CI, 1.9-5.1). “The presence of tenosynovitis was a significant factor in the development of arthritis,” Catrina said.
Other significant factors in the development of arthritis included anti-filaggrin peptide 307-320 antibodies (HR = 2.5; 95% CI, 1.4-4.3) and IL-6 (HR = 1.4; 95% CI, 1.2-1.7).
“We showed that we can identify a subgroup of high-risk individuals among those without symptoms but who have presence of anti-citrullinated protein antibodies,” Catrina said. – by Rob Volansky
Reference:
Catrina A. Abstract #1758. Development of ultrasound detectable arthritis among ACPA positive subjects with musculoskeletal symptoms: The RISK RA prospective study. Presented at: American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting; Nov. 9-13, 2019; Atlanta.
Disclosure: Catrina reports no relevant financial disclosures.