BackgroundNew ACR-EULAR SLE criteria have been proposed in order to attempt to improve classification for clinical and translational research (1, 2).ObjectivesWe evaluated the performance of the proposed 2017 ACR-EULAR classification criteria in a cohort of SLE patients with neuropsychiatric (NP) symptoms and compared to previous classification criteria.MethodsMedical records of patients visiting the NPSLE clinic of the Leiden University Medical Center (LUMC) between 2007-2017 were retrospectively evaluated. The performance of the proposed 2017 ACR-EULAR criteria, the 2012 SLICC criteria and the 1997 ACR criteria was evaluated by calculating sensitivity and specificity.Results360 patients were included, of which 294 were clinically diagnosed with SLE. The newly proposed 2017 ACR-EULAR showed a sensitivity of 87% (95% CI: 83-91%) and a specificity of 74% (95% CI: 62-84%), as shown in Table 1. The 2012 SLICC criteria had a sensitivity of 85% (95% CI: 80-89%) and a specificity of 76% (95% CI: 64-85%). The 1997 ACR criteria had a sensitivity of 89% (95% CI: 85-92%) and a specificity of 89% (95% CI: 80-96%).Sixty out of 294 patients fulfilled the proposed NP domain (delirium/psychosis/epilepsy). Using more specific criteria for NP symptoms related to SLE, as previously proposed by Bortoluzzi et al . (3), only 37 patients fulfilled this domain. However, this did not improve specificity, which remained 74% (95% CI: 62-84%).In addition, the performance of the newly proposed criteria was evaluated including patients with more than 10 points, but negative ANA. This led to an increase of sensitivity to 90% (95% CI 86-94%), but also did not influence specificity. Proposed 2017 ACR-EULAR classification criteria in SLE patients with NP symptoms With adjusted NP domain Including ANA negative patients Sensitivity (95% CI) 87% (83-91%)87% (83-91%)90% (86-94%) Specificity (95% CI) 74% (62-84%)74% (62-84%)74% (62-84%)Table 1 Performance of the proposed 2017 ACR-EULAR classification criteria for SLEConclusionIn a cohort of SLE patients with NP symptoms, the proposed 2017 ACR-EULAR classification criteria showed similar sensitivity as the 1997 ACR and the SLICC 2012 criteria, but lower specificity. Including ANA negative patients improved sensitivity.References[1] 2018ACR/ARHP Annual Meeting Abstract Supplement. Arthritis Rheumatol, 2018.70Suppl 9: p.1-355.[2] Tedeschi SK, et al., Developing and Refining New Candidate Criteria for Systemic Lupus Erythematosus Classification: An International Collaboration. Arthritis Care Res (Hoboken), 2018. 70(4): p.571-581.[3] Bortoluzzi A, et al., Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus. Rheumatology (Oxford), 2015. 54(5): p.891-8.Disclosure of InterestsRory Monahan: None declared, H.J.L. Beaart: None declared, Maka Gegeneva: None declared, E.G. Brilman: None declared, L.J.J. Beaart- van de Voorde: None declared, César Magro Checa: None declared, Thomas Huizinga Consultant for: Merck, UCB, Bristol Myers Squibb, Bio...
BackgroundWhat is the optimal glucocorticoid (GC) bridging therapy with MTX monotherapy in early arthritis?ObjectivesTo compare short term clinical efficacy of high and low dose GC tapering schedules with MTX monotherapy in 2 clinical trials in early rheumatoid arthritis (RA) and undifferentiated arthritis (UA) patients.MethodsIn tREACH, early RA and UA (arthritis in ≥1 joint(s),<1 year symptoms) patients were randomised to 3 different treatment arms. For this analysis we only use the data of arm C: oral GCs (prednisone) (15 mg/day, tapered to 0 in 10 weeks) with MTX monotherapy (25 mg/week); low dose GC tapering schedule (LDGC).In IMPROVED RA and UA (arthritis in ≥1 joint and ≥1 other painful joint,<2 years symptoms) patients were treated with prednisone (60 mg/day, tapered in 7 weeks to 7.5 mg/day, continued to 4 months)+MTX monotherapy (25 mg/week); high dose GC tapering schedule (HDGC). We compared%DAS-remission (<1.6) and low disease activity (≤2.4) at first evaluation (3 months tREACH, 4 months IMPROVED) and DAS and HAQ over time. After multivariate normal imputation we applied generalised estimating equations (GEE) for linear outcomes and logistic regression models for binary outcomes, adjusted for potential baseline confounders (figure 1). Adverse events were compared between treatment arms using χ2-square tests.ResultsPatients with a HDGC (n=610) had shorter symptom duration and higher HAQ, were less often seropositive (ACPA positive 56.0% vs 77.3%, RF positive 58.1% vs 65%) and more often had UA (20.3% vs 2.1%) than patients with a LDGC (n=97). Baseline DAS was comparable.At the first evaluation time point (median 3.06 (IQR 2.99–3.22) months in LDGC, 4.01. (3.8–4.17) in HDGC) DAS and HAQ had decreased significantly less after 3 months LDGC: DAS β (95% CI) 0.500 (0.276; 0.725), and HAQ 0.330 (0.189; 0.470) than after 4 months HDGC (figure 1).Compared to the HDGC patients, patients with the LDGC had a significantly lower chance of achieving DAS-remission 63.4% vs 28.9% (OR (95% CI) 0.215 (0.124; 0.373) and low disease activity 80.6% vs 55.7% ((OR (95% CI) 0.249 (0.143; 0.435)). Presence of ACPA was positively associated with achieving DAS-remission in the HDGC group, but not in the LDGC group. Per 100 patient years, 7.98 serious adverse events were reported in the HDGC and 23.4 in the LDGC (p=0.004). Hypertension, hyperglycemia (>7.8 mmol/L), gastrointestinal complaints and liverenzymes above normal were reported in similar frequencies across all groups. In patients with a LDGC more headaches, skin rashes, creatinine above normal range and any decrease in haematology blood counts were reported (data not shown).Abstract OP0030 – Figure 1 A:Predicted DAS over time, B: PRedicted HAQ over time. All predictions are from multiple imputed models, adjusted for age, gender body mass index, presence of ACPA, presence of rheumatoid factor, symptom duration, effect over time (in GEE) and baseline DAS (for binary out-comes). DAS, Disease Activity Score; HAQ Health Assessment Questionnarie; HD GC, high dose glucocortico...
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