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.
Longitudinal Assessment of Activity and Damage in a Synthetase Positive Cohort.
Cassidy1, Elaine A., Aggarwal3, Rohit, Fertig4, Noreen, Ascherman3, Dana P., Oddis2, Chester V.
Children's Hospital Pittsburgh Division of Rheumatology, Pittsburgh, PA
University of Pittsburgh, Pittsburgh, PA
University of Pittsburgh School of Medicine Division of Rheumatology and Clinical Immunology, Pittsburgh, PA
University of Pittsburgh School of Medicine Division of Rheumatology and Clinical Immunology
To compare disease activity and damage in a longitudinal cohort of Jo-1 and non Jo-1 anti-tRNA synthetase autoantibody (anti-synAb) positive patients (pts).
Since 2002 one investigator (CVO) has prospectively completed the Myositis Disease Activity Assessment Tool (MDAAT) and Myositis Damage Index (MDI) on pts with the data entered into the Myositis Data Management System (MDMS). All anti-synAb+ pts in MDMS were included in this analysis. The MDAAT includes an intention to treat component but only the visual analog scale (VAS) assessing disease activity at last visit in constitutional, cutaneous, skeletal, pulmonary, extramuscular global, muscle and overall global categories were used in this study. VAS activity scores were designated as: none=0; minimal (0<VAS<=1); mild (1<VAS<=3); moderate (3<VAS<=7) and severe (VAS>7). The groups were compared using Kruskal Wallis test for VAS scores, and the Chi-square test for ordinal VAS values. The MDI assesses organ system damage using a VAS and a dichotomous variable, and the 2 groups were compared using the last recorded organ system VAS score (Kruskal Wallis) and the presence or absence of organ damage using Chi-square test for skeletal, muscle, pulmonary, and global categories. Regression analysis was used to control for time from diagnosis and first visit to assessment of activity or damage.
Activity was assessed in 59 anti-synAb+ pts (41 Jo-1; 18 non-Jo-1) having at least 2 MDAATs in 1 year, or >3 over any time period. Damage was assessed in 71 pts (50 Jo-1; 21 non-Jo-1) that had >1 MDI. The Jo-1 and non-Jo-1 groups were similar in terms of gender and ethnicity. Median time in yrs (IQR) from diagnosis to last completed MDAAT was 5.8 (2.23.9) vs. 4.2 (2.08.7) for Jo-1 and non-Jo-1 pts (p=NS). The skeletal activity at last assessment was worse in Jo-1 pts as 71% had VAS = 0 compared to 95% of non Jo-1 pts (p=0.03). This remained significant after controlling for time from diagnosis or first visit to assessment (p=0.03). There were no differences in disease activity at last visit between Jo-1 and non Jo-1 pts in the other categories. Regarding damage, non-Jo-1 patients had significantly more damage from pulmonary hypertension (PHT) at last MDI (40% non-Jo 1 vs. 11% Jo-1 pts; p=0.005) which remained significant after controlling for time from diagnosis or first visit (p=0.006). Forty-two of 71 anti-synAb+ pts had pulmonary function tests at last MDI and %predicted FEV-1 (75 +/- 16 vs. 74 +/- 25) and %predicted DLCO (57 +/- 23 vs. 52 +/- 25) were similar for Jo-1 and non-Jo-1 pts (p=NS). There was no difference between groups in global disease damage at last visit [median VAS (IQR): 1.8 (0.653.25) and 2.2 (1.43.8), respectively]. No differences in damage between Jo-1 and non Jo-1 pts were noted in the other categories.
Jo-1 and non-Jo-1 anti-synAb+ pts have similar activity and damage scores at last follow-up for multiple organ systems. Jo-1 pts have increased arthritis activity while non-Jo-1 pts have increased PHT-related damage. Comparing these results to other autoantibody and myositis subsets will further validate the usefulness of these activity and damage indices.
To cite this abstract, please use the following information:
Cassidy, Elaine A., Aggarwal, Rohit, Fertig, Noreen, Ascherman, Dana P., Oddis, Chester V.; Longitudinal Assessment of Activity and Damage in a Synthetase Positive Cohort. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :925