Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Application of the New ACR/EULAR Classification Criteria for Rheumatoid Arthritis to At-Risk Populations May Identify RA Prior to Clinical Presentation.

Kolfenbach5,  Jason R., Derber5,  Lezlie, Deane9,  Kevin D., Hughes-Austin4,  Jan, Weisman3,  Michael H., Buckner2,  Jane, Mikuls11,  Ted R.

Oak Park, IL
University of Colorado Denver, Aurora, CO
University of Nebraska Medical Center, Omaha, NE
Benaroya Research Institute at Virginia Mason
Cedars-Sinai Medical Center, Los Angeles, CA
Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver
Division of Rheumatology, University of Colorado at Denver, Aurora, CO
N Shore Univ Hosp Rsch Ctr, Manhasset, NY
Univ of Colorado School of Med, Aurora, CO
University of Nebraska Medical Center, Omaha, NE
University of Colorado at Denver, Aurora, CO

Objective:

The proposed ACR/EULAR classification criteria were developed in part to identify early RA. Applying the new criteria to at-risk populations prior to evaluation in the health care setting may identify a unique cohort in which to study the evolution of very early symptomatic RA. We have established prospective cohorts of subjects at potentially higher risk for RA based on genetic risk factors as part of the SERA study (Studies of the Etiology of RA). The purpose of the current analysis was to identify and characterize a cohort within these populations with 'definite RA' according to the newly proposed criteria.

Methods:

We have established a cohort of first-degree relatives (FDRs) of probands with RA. FDRs without RA by the 1987 ACR criteria undergo a joint exam and have laboratory data obtained. Identical data is collected on a second at-risk DR4-enriched population containing parents of children with high risk HLA alleles and/or Type I diabetes. The proposed RA criteria were applied to subjects in these cohorts with swelling suggestive of synovitis in >= 1 joint on clinical exam after exclusion of findings attributed to alternative diagnoses (e.g. trauma, osteoarthritis). Data regarding joint distribution, duration of symptoms, antibody status and presence of elevated inflammatory markers were used to apply the new criteria. Descriptive statistics were calculated for the identified cases.

Results:

1790 subjects were available for analysis. 153 subjects (8.5%) had synovitis in >= 1 joint on clinical exam. 21 subjects (1.17%) had 'definite RA' according to the proposed algorithm. 17/21 (81%) subjects were female with a mean age of 48.9 years old. 6/21 subjects (28.6%) were positive for rheumatoid factor (RF), one (4.8%) was positive for anti-cyclic citrullinated peptide antibody, and 11 (52.4%) had elevated levels of CRP. Median swollen and tender joint counts were 3 and 11, respectively. The average total score in the 21 subjects was 6.76. The mean scores for joint involvement, serology, acute phase reactant and duration were 4.33, 0.9, 0.52 and 1.0, respectively (Table 1).

Table 1. Relative contribution of Clinical & Serologic factors to the designation of 'Definite RA' by the newly proposed ACR/EULAR Classification Criteria for RA*

Patient123456789101112131415161718192021
ACR Joint score535532555555255555533
ACR Serology score030023000000300003023
Acute Phase Reactant Score110001111100000011011
Duration score111111111111111111111
Total score7866677777666666710678
Score >= 6 indicates 'definite RA' according to the proposed algorithm*Scores derived from a single visit in which the subject achieved a score >= 6. Some subjects have additional visits 3 subjects with >1 visit with a score >= 6; first is depicted.

Conclusion:

Individuals with 'definite RA' according to the new criteria can be identified in these unique at-risk populations. A score >= 6 was driven primarily by joint involvement with the majority stemming from tender rather than swollen joints, a finding which may indicate an earlier phase of RA development than individuals presenting for clinical care. The identification of these subjects in a research rather than clinical setting may allow us to study an earlier phase of RA than possible in usual clinical practice. These subjects will be followed prospectively with multiple modalities including serial joint evaluations and biomarker assessments to evaluate the relationship between the new RA criteria and the longer-term evolution of RA.

To cite this abstract, please use the following information:
Kolfenbach, Jason R., Derber, Lezlie, Deane, Kevin D., Hughes-Austin, Jan, Weisman, Michael H., Buckner, Jane, et al; Application of the New ACR/EULAR Classification Criteria for Rheumatoid Arthritis to At-Risk Populations May Identify RA Prior to Clinical Presentation. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :658
DOI: 10.1002/art.28426

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