What Is the Relationship Between Morning Symptoms and Measures of Disease Activity in Patients With Rheumatoid Arthritis?

Background:Seropositive rheumatoid arthritis (RA) is characterized by the presence of rheumatoid factor (RF) and anti-citrullinated protein autoantibodies (ACPA) with different fine-specificities. Yet, other serum anti-modified protein autoantibodies (AMPA), e.g. anti-carbamylated (Carb), anti-acetylated (KAc), and anti-malondialdehyde acetaldehyde (MAA) modified protein antibodies, have been described. By using RA patient single-cell derived monoclonal antibodies we have previously shown that individual ACPA clones recognize small distinct citrulline-containing epitopes giving them extensive multireactivity when these epitopes are found in many peptides and proteins. Moreover, certain CCP2+ multireactive ACPA clones bind also to cabamylated and acetylated autoantigens [1].Objectives:To provide a comprehensive evaluation of serum IgG and IgA autoreactivity to different post-translational modifications in RA.Methods:We analyzed 30 different IgG and IgA AMPA reactivities to modified antigens by ELISA and autoantigen arrays, in N=1985 newly diagnosed RA patients and population controls. The study utilized both previously established (i.e IgG and IgA CCP2; IgG ACPA fine-specificities; IgG anti-Carb fibrinogen and Carb FCS; IgG and IgA Cit/Carb/KAc/Orn(Ac)-vimentin), and novel assays (e.g. IgG anti-MAA and IgG anti-acetylated histones). Association with patient characteristics such as smoking and disease activity were explored. The newly developed assays were also evaluated in SLE disease controls and CCP2+ RA-risk individuals without arthritis.Results:Carb and KAc reactivities by different assays were primarily seen in patients also positive for citrulline-reactivity. Modified vimentin (mod-Vim) peptides were used for direct comparison of different AMPA reactivities, revealing that IgA AMPA recognizing mod-Vim was mainly detected in subsets of patients with high IgG anti-Cit-Vim levels and a history of smoking. IgG acetylation reactivity was mainly detected in a subset of patients with Cit and Carb reactivity. Anti-acetylated histone 2B reactivity was RA-specific and associated with high anti-CCP2 IgG levels, multiple ACPA fine-specificities, and smoking. This reactivity was also found to be present in CCP2+ RA-risk individuals without arthritis. Our data further demonstrate that IgG autoreactivity to MAA was increased in RA compared to controls with highest levels in CCP2+ RA, but was not RA-specific, and showed low correlation with other AMPA. Anti-MAA was instead associated with disease activity and was not significantly increased in CCP2+ individuals at risk of RA. Notably, RA patients could be subdivided into four different subsets based on their AMPA IgG and IgA reactivity profiles.Conclusion:We conclude that autoantibodies exhibiting different patterns of ACPA fine-specificities as well as Carb and KAc reactivity are present in RA and may be derived from multireactive B-cell clones. Anti-Carb and anti-KAc could be considered reactivities within the “Cit-umbrella” similar to ACPA fine-specificities, while MAA is distinctly different.References:[1]Sahlström P, Hansson M, Steen J, Amara K, Titcombe PJ, Forsström B, Stålesen R, Israelsson L, Piccoli L, Lundberg K, Klareskog L, Mueller DL, Catrina AI, Skriner K, Malmström V, Grönwall C. Different Hierarchies of Anti-Modified Protein Autoantibody Reactivities in Rheumatoid Arthritis. Arthritis Rheumatol. 2020 Oct;72(10):1643-1657. PMID: 32501655Caroline Grönwall: None declared, Lisa Liljefors: None declared, Holger Bang Employee of: Employee at ORGENTEC Diagnostika GmbH, Aase Hensvold: None declared, Monika Hansson: None declared, Linda Mathsson-Alm Employee of: Employee at Thermo Fisher Scientific, Lena Israelsson: None declared, Anna Svärd: None declared, Cyril CLAVEL: None declared, Elisabet Svenungsson: None declared, Iva Gunnarsson: None declared, Guy Serre: None declared, Saedis Saevarsdottir: None declared, Alf Kastbom: None declared, Lars Alfredsson: None declared, Vivianne Malmström: None declared, Johan Rönnelid: None declared, Anca Catrina: None declared, Karin Lundberg: None declared, Lars Klareskog: None declared

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AB0101 THE IMPACT OF TIME SPAN TO ACHIEVE BOOLEAN REMISSION FOR MAINTAINING DISEASE ACTIVITY AFTER ACQUISITION IN RHEUMATOID ARTHRITIS PATIENT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.297 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1079.1-1079

Author(s):

I. Yoshii

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Disease Duration ◽

Remission Rate ◽

Mean Value ◽

Time Span ◽

Mean Values ◽

The Mean ◽

The Relationship

Background:Boolean remission criteria is one most popular and stringent criteria in treating patient with rheumatoid arthritis (RA), because it may guarantees a stable clinical course after attaining remission.Objectives:Impact of time span from initiation to achieving Boolean remission on maintaining disease activity, daily activities, and quality of life after attaining Boolean remission was investigated from daily clinical practice data.Methods:685 patients with RA since August 2010 under the T2T strategy were treated. They were monitored for their TJC, SJC, PGA, EGA, CRP, and disease activity indices such as CDAI, SDAI, DAS28, and Boolean criteria at every visit. HAQ-DI score, pain score using visual analog scale (PS-VAS), and EQ-5D were also monitored, and the quality of life score (QOLS) calculated from EQ-5D was determined at every visit from the time of diagnosis (baseline).Of 685 patients, 465 patients had achieved Boolean remission >1 times, and were consecutively followed up for >3 years. These patients were enrolled in the study. Time span from the first visit to first Boolean remission was calculated. The relationship between the time span and each of background parameters, and the relationship between the time span and each of the mean values of the SDAI score, HAQ score, PS-VAS, SHS, and QOLS at the first Boolean remission and thereafter was evaluated statistically.Patients were subsequently divided into the G ≤ 6 and G > 6 groups based on the achievement of first Boolean remission within two groups: time span G ≤ 6 months and G > 6 months. The two groups were compared with regard to the SDAI score, HAQ score, PS-VAS, SHS, and QOLS at first visit and at the time of first Boolean remission, and the mean values of these parameters after remission were evaluated statistically. Moreover, changes of these parameters and the mean Boolean remission rate after the first remission, and SDAI remission rate at the first Boolean remission to thereafter were compared between the two groups statistically.Results:Out of 465 patients, females comprised 343 (73.7%), and the mean age was 67.8 years (range, from 21–95 years). The mean disease duration at first visit was 6.1 years (range, from 1 months–45 years). The mean follow up length was 88.1 months (range: 36–122 months; median: 85 months) and mean time span from the first visit to the first Boolean remission was 8.1 months. The mean SDAI score, HAQ score, PS-VAS, and the QOLS at first visit were 13.3, 0.467, 33.2, and 0.834, respectively. Among the study parameters, PS-VAS and QOLS were significantly correlated with the time span. For parameters at the first Boolean remission, HAQ-DI score, PS-VAS, and QOLS demonstrated significant correlation with the time span, whereas SDAI, HAQ-DI score, PS-VAS, SHS, and QOLS after the Boolean remission demonstrated significant correlation with the time span.The comparison between the G ≤ 6 and the G > 6 groups revealed that the disease duration, HAQ score, and PS-VAS at baseline in the G > 6 were significantly higher than that in the G ≤ 6 group, and QOLS in the G ≤ 6 group was significantly higher than that in the G > 6 group at baseline. Similarly, the HAQ score and PS-VAS at the first Boolean remission in the G > 6 group were significantly higher than that in the G ≤ 6 group, whereas QOLS in the G ≤ 6 group demonstrated no significant difference compared with that in the G > 6 group.The mean value of the SDAI score after the first Boolean remission in the G > 6 group was significantly higher than that in the G ≤ 6 group. Similarly, the SDAI score, HAQ score, and PS-VAS after the first Boolean remission in the G > 6 group were also significantly higher than those in the G ≤ 6 group, and the mean value of the QOLS in the G ≤ 6 group were significantly higher than that in the G > 6 group. The Boolean remission rate and SDAI remission rate after the first Boolean remission were significantly higher in the G ≤ 6 group than those in the G > 6 group.Conclusion:Attaining Boolean remission ≤ 6 months for RA has significant benefit for more stable disease control, that leads good maintenance of ADL.Disclosure of Interests:None declared

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AB0211 The relationship between the elevated serum immunoglobulin g4 level and disease activity in patients with rheumatoid arthritis

10.1136/annrheumdis-2018-eular.4599 ◽

2018 ◽

Author(s):

C.-N. Son ◽

H.-J. Jeong ◽

J.-N. Chae ◽

J.-M. Kim ◽

S.-H. Kim

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Elevated Serum ◽

Serum Immunoglobulin ◽

Immunoglobulin G4 ◽

The Relationship

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Artrite Reumatoide e a Poluição do Ar

UNICIÊNCIAS ◽

10.17921/1415-5141.2020v24n2p195-200 ◽

2021 ◽

Vol 24 (2) ◽

pp. 195-200

Author(s):

Dayane Dos Santos Souza Magalhães ◽

Leticia Rosa Espírito Santo de Freitas ◽

Maria Amélia Dos Santos Peres Santos Souza ◽

Vander Fernandes ◽

Walkiria Shimoya-Bittencourt ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Air Pollution ◽

Disease Activity ◽

Air Pollutants ◽

Activity Index ◽

Age Groups ◽

Unknown Etiology ◽

World Population ◽

Artrite Reumatoide ◽

The Relationship

A artrite reumatoide é uma doença inflamatória, crônica, autoimune, sistêmica e progressiva com etiologia ainda desconhecida, que causa danos progressivos ao sistema musculoesquelético. Esta doença atinge aproximadamente 0,5% a 1% da população mundial, predomina no sexo feminino e acomete todas as faixas etárias com maior prevalência entre 40-60 anos. A atividade da doença é avaliada pelo Índice de Atividade da Doença (DAS28) analisando 28 articulações. Estudos demonstram que a poluição atmosférica está associada aos agravos à saúde humana e à perda de qualidade de vida. Este estudo teve como objetivo relatar o papel da poluição atmosférica na artrite reumatoide, através de uma revisão narrativa de literatura, a partir das bases de dados PubMed e Scielo. Incluíram-se artigos nos idiomas inglês e português publicados em periódicos, nacionais e internacionais, acerca da temática da pesquisa. A relação entre o desenvolvimento da AR e diferentes poluentes atmosféricos foi analisada em diversos estudos, que demostraram associação entre diferentes poluentes atmosféricos e o desenvolvimento da doença, no entanto, nenhum estudo publicado até a data atual, avaliou a relação com a exacerbação da atividade da doença. Palavras-chave: Artrite Reumatoide. Poluição do Ar. Doenças Autoimunes. Abstract Rheumatoid arthritis is an inflammatory, chronic, autoimmune, systemic and progressive disease with a still unknown etiology that causes progressive damage to the musculoskeletal system. This disease affects approximately 0.5% to 1% of the world population, predominates in females and affects all age groups with a higher prevalence between 40-60 years. The disease activity is assessed by the Disease Activity Index (DAS28) analyzing 28 joints. Studies show that air pollution is associated with damage to human health and loss of quality of life. This study aimed to report the role of air pollution in rheumatoid arthritis, through a literature narrative review, using the PubMed and Scielo databases. Articles in English and Portuguese published in national and international journals about the research theme were included. The relationship between the RA development and different air pollutants has been analyzed in several studies, which showed an association between different air pollutants and the development of the disease, however, no study published to date has evaluated the relationship with the disease activity exacerbation. Keywords: Rheumatoid Arthritis. Air Pollution. Autoimmune Diseases.

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