Ab0106 associated Factors for Presenting With Moderate to High Disease Activity on the First Rheumatology Visit in an Outpatient Clinic-Based Cohort of Colombian Ra Patients: A Real-World Cross-Sectional Study

Abstract

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