POS0481 KEY PREDICTIVE FACTORS AFFECTING RADIOGRAPHIC PROGRESSION IN DIFFICULT TO TREAT RHEUMATOID ARTHRITIS (2024)

Abstract

Background: We recently reported that 2.7% of rheumatoid arthritis (RA) cases were polyrefractory (failure/tolerance of all b/tsDMARD classes). However, 40% of D2T-RA patients including polyrefractory RA (PFRA), lacked objective joint inflammation signs on ultrasound (US)- termed non-inflammatory refractory RA (NIRRA) whilst the remaining cases had US determined persistent inflammatory refractory RA (PIRRA). [1] EULAR suggests that rapid radiographic progression (radiographic progression above 5 units per year according to the modified Sharp/van Der Heijde scoring system) may be useful for defining D2T-RA.

Objectives: We audited the use of x-rays for potential added value in D2T-RA to PFRA.

Methods: Radiographic progression was evaluated at 2 timepoints in EULAR defined D2T RA and compared to PFRA group (failed 4 or 5 therapies depending on autoantibody status). Both hands and feet images were scored using the modified Sharp/van Der Heijde scoring system blinded to the time of radiography. Annual radiographic progression was compared between PIRRA (PDUS+) and NIRRA (PDUS-) subgroups. Annual CRP levels were calculated using the area under the curve method and furthermore annualized due to heterogeneous follow-up periods to capture the cumulative burden of inflammation.

Conclusion: This study assessed which clinical factors, including ultrasound findings, were associated with radiographic progression in D2T and PFRA patients. The radiographic progression rates in D2T to PFRA are low in the majority of RA cases and don’t differ between groups suggesting not intrinsically more destructive phenotype in PFRA. Time integrated yearly CRP levels were the best predictor of radiographic progression. Classifying as PIRRA subgroup on PDUS in patients with clinically SJC also associated with radiographic progression. In D2T-RA patients, low CRP levels and lack of PD on US may predict a lower rate of radiographic progression, even with refractory disease.

Acknowledgements: NIL.

Disclosure of Interests: Kerem Abacar Amgen Partner Fellowship Program, Andrea Di Matteo: None declared, Paula David: None declared, Shouvik Dass: None declared, Paul Emery Abbvie, Gilead, Lilly and Novartis, AbbVie, BMS, Lilly and Samsung, BMS, AbbVie, MSD, Pfizer, Novartis and Roche, Benazir Saleem: None declared, Dennis McGonagle Janssen, Novartis, Lilly, Pfizer, UCB, Celgene, BMS, Janssen, Novartis, Lilly, Pfizer, UCB, Celgene, BMS, Janssen, Novartis, Lilly, Pfizer, UCB, Celgene, BMS.