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.

The Association of Joint Damage and Treatment Response with ACPA Status in Recent Onset RA.

van den Broek3,  M., Klarenbeek4,  N. B., Westedt1,  M. L., Boom5,  H. D., Kerstens2,  P. J. S. M, Huizinga4,  T. W. J., Dijkmans6,  B. A. C.

Bronovo Hospital, The Hague, The Netherlands
JBI, Amsterdam, The Netherlands
LUMC, Leiden, The Netherlands
LUMC, Leiden, The Netherlands
Spaarne Hospital, Hoofddorp, The Netherlands
VU Medical Centre, Amsterdam, The Netherlands


To compare clinical and radiological response to disease activity score (DAS) steered treatment in patients with recent onset RA who were positive or negative for anti-citrullinated protein antibodies (ACPA).


In the BeSt study, 508 recent onset RA patients were randomized to 4 treatment strategies, aimed at a DAS <=2.4: sequential monotherapy, step-up combination therapy, initial combination therapy including prednisone and initial combination therapy including infliximab. Chances of damage progression >5 (Sharp/vd Heijde score (SHS)) in 1 year, and >25 in 5 years, and rate of (drugfree) remission were compared for ACPA positive and ACPA negative patients, using logistic regression analysis. Functional ability over time, measured with the Health Assessment Questionnaire (HAQ), was compared using linear mixed models. The analyses were adjusted for gender, smoking habits and baseline age, DAS, and SHS


At baseline, ACPA positive patients (N=297) had more radiographic damage than ACPA negative patients (N=183): median SHS 4.0 (IQR 1.0–10.5) vs 1.5 (IQR 0–6.1), and a lower DAS (4.3 for the ACPA positive group, vs 4.6, p<0.001) and HAQ (1.3 vs 1.5, p=0.02). More ACPA positive patients were male (p=0.01) and more were smokers (p=0.01). DAS reduction was achieved similarly in ACPA positive and ACPA negative patients in all treatment groups figure. After 1 year of follow-up, the Odds ratio (OR) of SHS progression >5 was 3.27 (95% C.I. 1.68–6.35) for ACPA positive patients. After 5 years the OR of progression >25 was 5.95 (95% C.I. 2.02–17.52). Over time, there were no significant differences in HAQ between ACPA positive and negative patients. Odds ratio of ever achieving remission was 1.09 (95% C.I. 0.63–1.88) for ACPA positive patients, and of achieving remission during at least 1 year 0.75 (95% C.I. 0.49–1.16)). However, ACPA positive patients did have a lower chance of ever achieving drugfree remission (OR 0.46 (95% C.I. 0.28–0.72)) and a higher chance of restarting medication (OR 8.47 (95% C.I. 3.09–23.25)).

Figure. DAS over time and probability plot depicting radiographic progression (change in SHS) for ACPA positive and ACPA negative patients in 5 years.


Not the chance of remission, but the chance of (persistent) drugfree remission was lower in ACPA positive patients compared to ACPA negative patients. Treatment response was similar in both groups, irrespective of initial treatment and baseline characteristics. However, more ACPA positive patients had significant radiographic damage progression. This may suggest that, in ACPA positive patients, treatment decisions should be based on disease activity, but also on damage progression.

To cite this abstract, please use the following information:
van den Broek, M., Klarenbeek, N. B., Westedt, M. L., Boom, H. D., Kerstens, P. J. S. M, Huizinga, T. W. J., et al; The Association of Joint Damage and Treatment Response with ACPA Status in Recent Onset RA. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :663
DOI: 10.1002/art.28431

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