POS0448 Identification of joint locations in an early rheumatoid arthritis cohort as a characteristic of disease severity and response to Methotrexate, data from the ERA-Uclouvain Brussels Cohort

BACKGROUND: Early RA patients (ERA pts) often present with different areas of joint involvement, but limited data exist to identify which specific joint locations may be indicative of greater disease severity. OBJECTIVES: This analysis investigated the baseline (BL) prevalence of swelling, tenderness and erosions in individual joint locations and their possible association with disease characteristics, prognostic factors and response to Methotrexate (MTX) in a cohort of ERA pts. METHODS: This analysis was based on data from the ERA UCLouvain Brussels cohort in which patients were included according the ACR/EULAR 2010 criteria and naïve to DMARDs. The physician assessed prevalence of BL individual swollen and tender joint status (present, absent) through a physical examination. The joint count includes 44 joints. Similarly, all patient and RA characteristics were collected. The association between BL swelling, tender, erosions and disease characteristics was investigated for each individual joint. Remission rates (DAS28-CRP < 2.6) in patients treated only with MTX were assessed in order to analyze the correlation with BL joint location. [..

Editorial: Risk factors for Rheumatoid Arthritis and pre-Rheumatoid Arthritis

No abstract availabl

Anti-TNF Induced Sarcoidosis-Like Disease in Rheumatoid Arthritis Patients: Review Cases from the RA UCLouvain Brussels Cohort.

Drug-induced sarcoidosis-like disease is a rare side effect of anti-tumor necrosis factor (anti-TNF) agents in rheumatoid arthritis (RA) patients. The most commonly involved organs in such condition are the lungs, skin, and lymph nodes. The aim of this study is to report the number of cases and the clinical manifestations of sarcoidosis induced by anti-TNF in our RA UCLouvain Brussels cohort. All case records of RA patients ever treated with a TNF inhibitor and presenting anti-TNF induced sarcoidosis in our rheumatology centers from 2000 to 2021 were retrospectively reviewed. Our RA UCLouvain Brussels cohort includes 2492 patients. Among them, 697 patients have been or are exposed to a TNF inhibitor. Only four patients with sarcoidosis induced by anti-TNF were identified and reviewed. Patient 1 was classified as incomplete Heerfordt syndrome. Patient 2 was a case of sarcoid-like granulomatosis manifesting as life-threatening hypercalcemia, acute kidney injury and atypical parenchymal pneumopathy. Patients 3 and 4 developed pulmonary sarcoidosis with hilar adenopathies. The TNF inhibitor was etanercept for the first three patients and infliximab for the last one. The time occurrence of sarcoidosis was highly variable after anti-TNF exposure. All patients recovered after glucocorticoid treatment and the discontinuation of the anti-TNF agent. This case highlights this rare paradoxical side effect and the variability of the clinical presentation. Further studies should analyze the immunopathology of such conditions

Should we use glucocorticoid in Early Rheumatoid Arthritis?: Results at 5 years from the ERA UCLouvain Brussels cohort.

To evaluate the proportion of patients with ERA who have initiated or not GC, to analyse the baseline characteristics, and to assess the clinical benefit and side effects of GC during 5 years of follow-up. We included patients with ERA from the UCLouvain Brussels cohort who met the ACR/EULAR 2010 classification criteria and were naïve to cDMARDs. We retrospectively collected patient characteristics prior to the introduction of cDMARDs with or without GC. Efficiency and serious adverse events were analysed at 6, 12, 36 and 60 months. Data from 474 eligible ERA patients were collected. 180 patients initiated GC compared with 294 who did not.At baseline, the increased CRP is the main factor that favors the initiation of GC followed by smoking, absence of ACPA, prescription of methotrexate as a monotherapy and age.5 years follow-up of DAS28-CRP, HAQ or VAS pain values did not differ between the two groups.We also analysed a subgroup of 139 patients who received >1 g of prednisolone during the 5 years period. We confirmed the same baseline differences and observed in addition more males and higher DAS-28CRP values. During the 5 years follow up, DAS-28CRP, VAS pain and HAQ remained significantly higher in this subgroup. More severe infections were also reported. In our ERA cohort, the initiation of GC treatment does not bring additional benefit for the short and long-term control of the disease. GC was more prescribed in seronegative RA patients with a higher level of inflammation. the authors declare no conflicts of interest. authors declare that the study complies with the Declaration of Helsinki

COVID-19 IN MY RA CLINIC: DATA FROM QUESTIONNAIRE, VACCINATION, INFECTION AND FLARES FROM THE RA LOUVAIN BRUSSELS COHORT

Background Over 5 million deaths from the COVID-19 disease have been reported in the world. Patients (pts) living with rheumatoid arthritis (RA) affecting the immune system or under immunosuppressive agent are considered as a high risk population for a SARS-CoV-2 infection. Since no antiviral treatment is available, the vaccination is a major option. Objectives The aim of this study is to evaluate in our RA cohort a questionnaire about the COVID-19 vaccination willingness, to analyse the vaccination rate, the number of COVID infection, the RA flares and the side effects. Methods We included pts with RA from the UCLouvain Brussels cohort who met the ACR/EULAR 2010 classification criteria. A simple and standard questionnaire about the vaccine willingness was distributed in 2020 before the vaccination. From January to December 21, the rate of vaccination was calculated. The number of Covid infections, RA flares, therapy switches and side effects were also collected. All patient and RA characteristics were analyzed. Results 605 eligible RA pts were included. The average age of the population is 58.21 years. 72% of the patients are women. 21% are smokers and 65% are positive for anti-citrullinated protein antibody (ACPA) with a mean DAS28-CRP of 2.39 and a mean HAQ of 0.821. In 2020, 460 pts filled the questionnaire and 61% indicated they would receive the vaccine as soon as it is available. For the 179 pts (39%) who decline, the reasons for not having vaccine were no trust in the vaccine at this time (53%), fear of side effects (28%), opposition to vaccine (4%), previous SARS-CoV-2 infection (2%) and unknown (5%). Pts under the age of 50, women, low education grade, smokers, presence of RF/ACPA and treatment with a bioDMARD were less willing to receive the vaccine. In 2021, 538 pts were vaccinated and only 67 pts (11.1%) not. The majority received a mRNA vaccine (81.8%). 72 and 21 pts developed a SARS-CoV-2 infection before and after the vaccination, respectively. Among them, 5 were admitted to intensive care unit leading to 4 deaths. Only, 7 RA flares were observed and 17 pts switched the therapy. 101 adverse events were reported. All of them were mild and transient except 2 cases with pulmonary embolism and one case with Herpes Zooster infection. Conclusion The SARS-COV-2 global pandemic is responsible of many medical dramas. In our RA cohort, we observed first hesitation followed by a high rate of vaccination. The safety was reassuring with a minimal number of RA flares and serious adverse events including only 4 deaths

POS1345 Pain over 5 years in our early rheumatoid arthritis UCLouvain Brussels Cohort: results and correlation with clinical response, quality of life

BACKGROUND: Pain is a major patient reported outcome in early rheumatoid patients (ERA). Pain is associated with disease activity but could be also related to non-inflammatory conditions. Chronic pain has a negative impact on quality of life in ERA patients. The main treatment objective in ERA is remission or low disease control, but relief of pain is a priority of patient. OBJECTIVES: To evaluate the pain course and the proportion of unacceptable pain (VASp >4) during a five-years follow-up in ERA patients and to investigate correlation with clinical response and quality of life. […

Polyarthrite débutante : intérêt de la rémission précoce

La polyarthrite est une affection inflammatoire chronique, d’origine immunitaire, caractérisée par une atteinte du tissu synovial pouvant détruire progressivement les articulations associée parfois à des manifestations extra-articulaires. Ce rhumatisme, très hétérogène, peut causer des douleurs invalidantes, un handicap fonctionnel, entrainant une importante réduction de la qualité de vie. Le diagnostic précoce et une meilleure compréhension de sa physiopathogénie ont permis, grâce à la recherche translationnelle, de développer de nouvelles stratégies thérapeutiques, avec un changement substantiel dans la prise en charge de cette affection

Should We Use bDMARDs as an Induction Therapy in Early and Severe Rheumatoid Arthritis? Results at 5 years from the ERA UCLouvain Brussels Cohort.

This study sought to analyze the benefit of an early induction therapy with a biological disease-modifying anti-rheumatic drugs (bDMARD) during the first year of treatment with a 5-year follow-up in early rheumatoid arthritis (ERA). We included ERA patients from the UCLouvain Brussels cohort who met the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2010 classification criteria and were naïve to DMARDs. ERA patients were divided into two groups according to whether they received an induction bDMARD therapy or a standard therapy with methotrexate (MTX). Clinical response after the induction treatment at 6 and 12 months followed by a MTX maintenance therapy at 36 and 60 months was evaluated. Data from 470 ERA patients were collected, 189 received a bDMARD and 281 initiated MTX alone. In the bDMARD group, disease activity and HAQ were higher at baseline. A total of 391 patients were followed up to 5 years. We then divided each group into two subgroups according to the last treatment they received at 5 years: bDMARD > MTX (n = 95), bDMARD > bDMARD (n = 59); MTX > MTX (n = 134), MTX > bDMARD (n = 103). During the induction, we observed a clinical response with a large number of patients achieving DAS28-CRP remission. According to a treat-to-target (T2T) approach, remission rate was stable on MTX monotherapy or rescued by the addition or prolongation of a bDMARD. Interestingly, bDMARD followed by a MTX maintenance therapy experienced a stable and sustained DAS28-CRP remission rate in 53% of the ERA patients at year 5. Long-term remission is an achievable goal in ERA. Our results suggest that a bDMARD induction therapy followed by MTX maintenance therapy could be an interesting option