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.


Smoking Is a Predictor of Very Early Presentation with Rheumatoid Arthritis.

Sharpley1,  David W., Chitale2,  Sarang, Estrach2,  Cristina, Thompson2,  Robert N., Moots2,  Robert J., Goodson2,  Nicola J.

Academic Rheumatology Department, Aintree University Hospitals, University of Liverpool, Liverpool, Merseyside, United Kingdom
Academic Rheumatology Department, Aintree University Hospitals, University of Liverpool

Background:

Starting disease modifying anti-rheumatic drug (DMARD) treatment very soon after rheumatoid arthritis (RA) symptoms develop may significantly alter the disease course in early RA (eRA) (1). Early arthritis clinics (EAC) have been set up to allow for rapid assessment and initiation of DMARD therapy for eRA. Symptom duration varies in eRA patients with some presenting with very early RA (veRA), defined as a symptom duration <=12 weeks. These veRA presenters may differ from eRA patients with longer symptom duration at presentation.

Aim:

The aim of this study is to identify predictors and disease characteristics associated with veRA presentation to an EAC.

Methods:

New attendees at an EAC between May 2006 & March 2010 with eRA or probable eRA by ACR-EULAR 2010 criteria were identified. Symptom duration (weeks), smoking status, disease activity score (DAS-28), baseline radiograph & ultrasound findings, ESR, rheumatoid factor (RF) & anti-citrullinated protein antibody (ACPA) status, and other variables were recorded at presentation. Univariate, age & gender adjusted, & multivariate logistic regression were performed to identify predictors of very early presentation. Stratified analysis by ACPA status was also performed.

Results:

225 patients with eRA or probable eRA had a median age of 59 yrs [IQR 48, 70]. 140 (62%) female, 157 (70%) ACPA positive & 164 (73%) RF positive patients were identified. 189 (84%) had eRA by ACR-EULAR 2010 criteria & 89 (40%) presented within 12 weeks. Age & gender adjusted analyses revealed that, compared to later eRA presenters, veRA patients had higher ESR titres, tender & swollen joint counts & DAS-28 scores, but were less likely to be ACPA positive at presentation. Multivariate modelling identified smoking, ACPA negative status and ESR as independent predictors of veRA presentation (Table 1). ACPA stratified analyses revealed that the association between smoking & veRA presentation was considerably stronger in ACPA negative patients (OR 15.55, 95% CI 1.61, 149.70) compared to that seen in ACPA positive patients (OR 2.23, 95% CI 1.11, 4.46).

Table 1. Multivariate model predicting veRA presentation

Presentation with veRAOdds Ratio95% Confidence Interval
Age1.000.981.02
Gender1.120.622.02
Current smoker2.761.455.25
ACPA positive0.320.170.62
ESR1.021.011.03

Conclusions:

Smoking is associated with very early presentation and this association appears to be influenced by ACPA status in eRA. Interestingly, veRA patients were less likely to be ACPA positive at baseline. This may represent very early capture of patients prior to the development of ACPA.

Those with veRA had more active disease but less joint damage on ultrasound investigation. These veRA patients may benefit from early DMARD therapy to prevent joint damage and treatment within the window of opportunity may alter their disease course. It is interesting to note that in established RA, smoking is associated with more severe radiological, disability and mortality outcomes. Early remission induction in veRA presenters who smoke could improve these long-term outcomes.

1)van Dongen,  (Arthritis Rheum 2007; 56(5):1424)

To cite this abstract, please use the following information:
Sharpley, David W., Chitale, Sarang, Estrach, Cristina, Thompson, Robert N., Moots, Robert J., Goodson, Nicola J.; Smoking Is a Predictor of Very Early Presentation with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :661
DOI: 10.1002/art.28429

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