Background:Rheumatoid arthritis (RA) is characterized by autoantibody formation and expansion such as the rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA), and antinuclear antibodies (ANA). Autoantibody identification has been considered as crucial not only for the diagnosis but also for its eventual association with the disease activity, to the extent of playing a pivotal role as a poor prognostic factor among patients1.Objectives:Our aim was to assess the eventual association between certain clinical-epidemiological factors and presenting with moderate to high disease activity on the first rheumatology visit in an outpatient clinic-based cohort of Colombian RA patients.Methods:We conducted a cross-sectional analytic study utilizing the database of an outpatient clinic based in the Rheumatology Department at Fundación Santa Fe de Bogotá University Hospital. Data were collected from May 2013 until Sep. 2020 and included age, gender, autoimmune- and non-autoimmune comorbidities, family history of autoimmunity (including RA), smoking and alcoholism personal history, previous DMARD and oral steroid use, nutritional status, disease duration defined as established or early RA (disease duration of ≤1 year before starting a DMARD), autoantibody profile information (RF, ACPA, and ANA), and disease activity, assessed by the DAS28- ESR. Multiple logistic regression with backward selection was performed to build the final fitted model.Results:Data from a total of 1229 patients were included in the analysis. Our population was primarily female (n=938, 76,3%), the majority had an initial diagnosis of established RA (n=952 (77,5%), and presentation on the first consultation with moderate to high disease activity was seen on 65,2% of the cases (n=801). Being male and having an autoimmune comorbidity were statistically significant associated protective factors whereas strongly positive RF and ACPA levels, positive high ANA titres, and established RA were recognized as risk factors after adjustment for the effects of possible confounders such as age, smoking status, previous DMARD use, and family history of RA. Table 1 provides the complete results obtained from the multiple logistic regression model.Table 1.Multiple logistic regression analysis’s results.OR (95% CI)p-valueMale0,52 (0,39 – 0,69)< 0,0001Age0,99 (0,99 – 1)0,24Autoimmune Comorbidities0,41 (0,21 – 0,80)0,009Family History of RA0,85 (0,61 – 1,14)0,26Current Smoking1,26 (0,78 – 2,07)0,29History of Smoking1,26 (0,81 – 2)0,30Previous DMARD use0,91 (0,70 – 1,18)0,45RF strong titers i.e., > 80 U/ml1,56 (1,21 – 2,02)0,0007ACPA strong titers i.e., > 80 U/ml1,59 (1,19 – 2,11)0,0016ANA low positive titers i.e., < 1:640 dil.0,94 (0,72 – 1,12)0,67ANA strong titers i.e., > 1:640 dil.1,98 (1,23 – 3,27)0,0063Disease duration (established RA)1,41 (1,05 – 1,90)0,0277Bold values indicate statistically significant.Conclusion:These findings have significant implications for the understanding of the disease activity evaluated on the first contact of a RA patient with a rheumatologist. Our data supports the consideration of being male as a protective factor; however, suggest that autoimmune comorbidities could also condition a lower disease activity for such scenarios, which may be explained by the fact that such patients were referred from- and already being treated by- other practitioners. Additionally, our research provides insights for the consideration of high ANA titers as a potentially poor prognosis factor to be identified as early as on the first visit. ANA’s use on daily practice is an intriguing matter which could be usefully explored in further research with distinct methodological approaches.References:[1]Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the Rheumatic Diseases 2020;79:685-699.Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease characterized by cartilage and bone destruction, which can lead to joint dysfunction and disability. Antibodies’ role as biomarkers in RA has been recently increasing: Anti-citrullinated protein antibodies (ACPAs) are the most specific one (60–70% of cases); whereas rheumatoid factor (RF) is seen in nearly 70% of cases, however, it is less specific than ACPA for RA diagnosisi. ACPA/RF positivity is related to a more severe phenotype and a rapid progression to clinically apparent RAii. Other biomarkers are Antinuclear Antibodies (ANAs), which have been related to a worse response to bDMARD treatmentiii.iNishimura K, Sugiyama D, Kogata Y, Tsuji G, Nakazawa T, Kawano S, et al. Meta-analysis: Diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Vol. 146, Annals of Internal Medicine. American College of Physicians; 2007. p. 797–808.iiLingampalli N, Sokolove J, Lahey LJ, et al. Combination of anti-citrullinated protein antibodies and rheumatoid factor is associated with increased systemic inflammatory mediators and more rapid progression from preclinical to clinical rheumatoid arthritis. Clin Immunol. 2018;195:119-126.iiiIshikawa Y, Hashimoto M, Ito H, Tanaka M, Yukawa N, Fujii T, et al. Anti-nuclear antibody development is associated with poor treatment response to biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis. Semin Arthritis Rheum. 2019;49(2):204–10.Objectives:Our aim was to compare in terms of mean differences the disease activity according to the presence of RF, ACPA, and ANA in an outpatient clinic-based cohort of Colombian RA patients.Methods:We conducted a retrospective cohort study with clinical-epidemiological data obtained from May 2013 to Feb. 2020 of patients with RA diagnosis based on the 2010 ACR/EULAR classification criteria. The patients were stratified into eight subgroups according to their autoantibody status. Disease activity, assessed by the DAS28-ESR, was recorded at baseline and after 3, ≈ 12, ≈ 24, and ≈ 36 (+/- 3) months. Mean DAS28-ESR differences were calculated by applying the Wilcoxon non-parametric rank test for two independent samples.Results:Data of 384 patients who all completed 36 months of follow-up, from an ongoing cohort of ≈1100 patients, were included in the analysis. On our primarily female (n=294, 76,8%) population, RF+ / ACPA+ / ANA+ subgroup was the most prevalent (n=183; 47,8%); interestingly, it was the one with the highest disease activity at baseline. After three months, all showed disease activity reduction; however, when completing follow-up, triple-positive, triple-negative and ANA-positive patients did not reach remission. Statistically significant mean differences were displayed when comparing overall and baseline mean DAS28-ESR scores for ANA+ vs ANA- patients, as shown in table 1.Table 1.Disease activity mean differences when comparing ANA+ vs ANA- patientsBaselineANA+(n = 218)ANA-(n = 165)Mean differencep value4,053,620,430,01433,323,140,180,396123,132,890,240,059242,802,680,110,563362,802,580,220,098Overall3,222,980,240,002Conclusion:In our study population, triple-positive and ACPA+/ANA+ patients showed higher disease activity at baseline and on average during the follow-up period; furthermore, ANA positivity was shown to be conditional on a significant difference for higher disease activity. RF and ACPA positive have long since been described as determinants for disease activity; nonetheless, our research provides insights for the consideration of ANA titers as a novel addition that enables the preamble of triple-positivity as something to be acknowledged. Caution must be applied when interpreting these results, understanding the need for this matter to be subject of future research with greater sample size, and taking into account other potentially confounder variables.Figure 1.Mean disease activity for each stratumDisclosure of Interests:None declared

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Objectives Assessing disease activity in rheumatoid arthritis (RA) patients requires comprehensive quantification of tender and swollen joints. We aimed to evaluate the correlation and agreement between rheumatologists after a training session dedicated to the standardization of synovitis assessment and compare its performance with a reference imaging modality such as musculoskeletal ultrasonography (MSUS). Methods In this cross-sectional study, a total of 28 and 10 joints in RA patients were evaluated by physical examination and ultrasound (US), respectively. After participating in a training session, individual joint assessment for tenderness and swelling was performed by three rheumatologists. MSUS examination was performed separately by an experimented radiologist in a standardized manner, evaluating findings according to the Outcome Measures in Rheumatology Clinical Trial (OMERACT) guidelines. Results A total of 80 RA patients were included, with a mean Disease Activity Score based on 28 joints (DAS28)-ESR of 4.02. The interobserver overall agreement and concordance rate in a total of 2240 joints assessed was 81.7% (k = 0.449, p < 0.0001) for tender joints and 66% (k = 0.227, p < 0.0001) for swollen joints. The overall concordance rate was fair (Fleiss' kappa = 0.21, p = 0.027) with an overall agreement of 67.18% yet, more joints were found to be swollen by the US assessment, compared to the physical examination (43% vs 39%). Conclusion In our study population, joint tenderness showed better interobserver agreement, correlation, and concordance rate than joint swelling. When comparing the US assessment to the physical examination, a fair overall concordance rate supports the need for the implementation of training sessions dedicated to standardization in rheumatology clinics.