POS1303 ARTHRITIS AND RISK STRATIFICATION OF PATIENTS WITH VERY EARLY SYSTEMIC SCLEROSIS

Abstract

BackgroundRegular monitoring of patients with very early systemic sclerosis (veSSc) is essential for detecting disease progression. Whereas arthritis is associated with a worse prognosis in established disease [1], knowledge about its relevance in veSSc is scarce.ObjectivesOur objective is to assess the prevalence of arthritis in patients with veSSc, its association with other disease features and its impact on progression to established SSc.MethodsWe included patients with veSSc defined as presence of Raynaud’s phenomenon and at least one of puffy fingers, antinuclear antibodies (ANA), abnormal capillaroscopy, not fulfilling the ACR/EULAR 2013 classification criteria for SSc at baseline. Data about arthritis were based on clinical diagnosis of synovitis by the treating physician, and verified in the electronic records in order to exclude arthritis due to other causes.We investigated associations between arthritis and relevant clinical parameters cross-sectionally at baseline using Fishers’ and Mann-Whitney-U tests. A longitudinal analysisusing Kaplan-Meier plots and multivariable Cox regression was performed to investigate arthritis as a potential predictor of progression towards established SSc (fulfilment of ACR/EULAR criteria at any follow-up visit).ResultsOf 161 patients included, 110 had at least one follow-up visit, with a median follow-up of 2.0 years. Baseline characteristics are shown in the Table 1. SSc-related arthritis was reported in 22/161 (13.7%) patients and was mostly seronegative (20/22, 90.9%), only one patient having an overlap syndrome with seropositive rheumatoid arthritis.Table 1.Baseline characteristicsVariableFrequency/MedianAge, median (years) (IQR, Q1-Q3)48 (25, 35-60)Female144/161 (89.4%)2013 EULAR/ACR classification criteria fulfilled at any time during follow-up45/161 (28%)Disease duration since first Raynaud symptom (years; median, IQR, Q1-Q3)3.1 (9.33, 1.08-10.42)SSc-related synovitis (n, %)22/161 (13.7%)CRP elevation (n, %)18/153 (11.8%)ESR elevation (>25mm/1h; n, %)16/144 (11.1%)Anti-centromere positive (n, %)83/155 (53.5%)Anti-Scl-70 positive (n, %)13/153 (8.5%)Anti-RNA Polymerase III positive (n, %)12/135 (8.9%)ILD on HRCT (n, %)10/135 (7.4%)SSc pattern on nailfold capillaroscopy (n, %)82/161 (50.9%)Digital ulcers (n, %)5/135 (3.7%)Pitting scars (n, %)3/136 (2.2%)Puffy fingers (n, %)33/147 (22.4%)Modified Rodnan skin score (median, IQR, min-max)0 (0, 0-4)Abbreviations: ILD-interstitial lung disease; HRCT-high resolution tomography; CRP C-reactive protein; ESR erythrocyte sedimentation rateWe found a statistically significant association between arthritis and presence of anti-centromere antibodies (p=0.008). Arthritis was neither associated with the other SSc-specific antibodies (anti-Scl70 and anti-RNA-Polymerase III), nor with inflammatory markers. Overall, 45/161 (28%) patients progressed to established SSc during follow-up. There was no statistically significant difference in fulfilling the classification criteria at follow-up between patients with- and without arthritis (Figure 1).Figure 1.Kaplan Meier analysis for progression to SSc stratified by SSc-related arthritis.Furthermore, arthritis was not a significant predictor for progression to established SSc in a multivariable Cox regression model adjusted for known predictors (specific antibodies, puffy fingers and SSc pattern on capillaroscopy [2]). In this model only the specific antibodies (p = 0.036) and puffy fingers (p = 0.045) reached significance.ConclusionIn this first study analysing arthritis in veSSc, we found a relevant prevalence of arthritis in this mildly affected cohort. Presence of anti-centromere antibodies was significantly associated with arthritis at baseline. Arthritis was not a prognostic factor for progression towards established SSc in our cohort.Reference[1]Avouac, J., et al., Joint and tendon involvement predict disease progression in systemic sclerosis: a EUSTAR prospective study. Ann Rheum Dis, 2016. 75(1):p.103-9.Acknowledgements:NIL.Disclosure of InterestsSinziana Muraru Grant/research support from: Congress Fee Support AstraZeneca 2021, Carina Mihai Consultant of: received consulting fees and/or honoraria from Boehringer Ingelheim, Janssen, MED Talks Switzerland, Mepha, and PlayToKnow AG, Grant/research support from: congress support from Boehringer Ingelheim and Roche, Mike O. Becker Speakers bureau: consulting, speaker fees or congress support from Mepha, Bayer, MSD, GSK, Amgen, Novartis and Vifor, Consultant of: consulting, speaker fees or congress support from Mepha, Bayer, MSD, GSK, Amgen, Novartis and Vifor, Grant/research support from: consulting, speaker fees or congress support from Mepha, Bayer, MSD, GSK, Amgen, Novartis and Vifor, Muriel Elhai Consultant of: BMS, Grant/research support from: Support for travel (Janssen), Suzana Jordan: None declared, Alexandru Garaiman: None declared, Cosimo Bruni Speakers bureau: Speakers bureau: Eli-Lilly, Consultant of: Consultant of: Boehringer Ingelheim, Grant/research support from: Grant/research support from: Gruppo Italiano Lotta alla Sclerodermia (GILS), European Scleroderma Trials and Research Group (EUSTAR), Foundation for research in Rheumatology (FOREUM), Scleroderma Clinical Trials Consortium (SCTC). Educational grants from AbbVie., Oliver Distler Speakers bureau: Speaker fee: Bayer, Boehringer Ingelheim, Janssen, Medscape, Consultant of: Consultancy fee: 4P-Pharma, Abbvie, Acceleron, Alcimed, Altavant Siences, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Redxpharna, Roivant, Sanofi and Topadur.Consultancy fee for rheumatology topic: Pfizer (2021)Consultancy fee: Abbvie, Grant/research support from: Research Grants: Kymera, Mitsubishi Tanabe, Boehringer Ingelheim, Rucsandra Dobrota Speakers bureau: Actelion, Consultant of: Boehringer Ingelheim, Grant/research support from: Congress suport Amgen, Grants Actelion, Pfizer.