THU0114 Influence of autoantibody status in time to initiate dmards in patients with early rheumatoid artrhitis

Abstract

BackgroundFactors contributing to an early referral to Rheumatologist and DMARDs initiation following symptom onset in rheumatoid arthritis (RA) patients are unclear. Recent data suggest that ACPA/RF double seropositivity is associated with delayed presentation to primary care and DMARDs initiation. Identification of these factors is mandatory to faciliate an early diagnosis and treatment of RA patients.ObjectivesTo determine whether time to DMARDs initiation and time to first visit at early arthritis clinic (EAC) following symptoms onset differs between RA patients according to autoantibody status.MethodsA prospective analysis of an EAC cohort including 1377 referred patients from 1993 to 2017 was undertaken for this study. Patients diagnosed of RA (according to physician’s diagnosis) were selected. Based on the serological status, we clasified patients in 4 groups: RF+/ACPA+, RF-/ACPA+, RF+/ACPA-, RF-/ACPA-. A baseline clinical assessment was completed including time (months) from symptoms onset to first assessment at EAC and to DMARD initiation. First, differences between serotypes were tested using chi-squared and student-t tests. Second, univariable and multivariable logistic regression models taking into account confounding factors (age, smoking and baseline DAS28)were employed to evaluate the association between autoantibody status and both periods: time to first visit at EAC and to DMARDs initiation.ResultsA total of 463 RA patients were included for analysis, of whom 292 (63.1%) were RF/ACPA double-seropositive (RF+/ACPA+),35 (7.6%)RF-/ACPA+,39 (8.4%) RF+/ACPA- and 92 (19.9%)RF-/ACPA-. Demographic and clinical data are shown in table 1. In the univariate analysis, statiscally significant differences were observed for both periods when patients were stratified by autoantibody serotype, where RF+/ACPA +individuals experienced the longer delay to presentation at EAC compared with RF-/ACPA- (5.0±4.6 vs 3.5±3.4 months;p<0.05). RF+/ACPA +patients experienced also significantly longer symptom duration before DMARD initiation than RF-/ACPA- (7.4±11.2 vs 4.9±5 months;p<0.05). In the univariable analysis, autoabtibody status (doble seropositive and RF-/ACPA +vsRF-/ACPA-) was signficantly asssociated with time to DMARDs initiation. However, after adjusting by confounding factors in the multivariable analysis, the autoantibody status did not remain significantly associated with time to initiate DMARDs (RF+/ACPA-; ß 0.186; p=0.1, RF-/ACPA+; ß 0.112; p=0.3, RF+/ACPA+; ß 0.228; p=0.1)Beta95% C.I. LowerUpper Non adjustedRFpositive,035−2,4624944ACPApositive,104,0387736Double-seropositive,120,1574791AdjustedRF positive,186−4,95226 414ACPA positive,112−14,51237 175Double-seropositive,228−2,52020 308DAS 28-,239−7,575,144Age-,073-,384,207Smoker-,066−14,9969118Former smoker-,081−19,05110 942Abstract THU0114 – Table 1Baseline characteristics of patients, stratified by autoantibody statusConclusionsIn our EAC cohort, time to EAC presentation and DMARD initiation following symptom onset in early RA does not differ according to pa...