[ACR22] Rheumatoid Arthritis I – Clinical (Non-therapeutic)

Author: Emanuele Bozzalla Cassione

Leuchten et al (0265) analyzed the impact of synovitis in ankle and MTP joints on RA score and disease activity states across 7,577 visits. Foot joints involvement scored higher on CDAI (9.1 vs 3.4, p<0.001) and DAS28 (3.19 vs 2.45, p<0.001) due to higher PGA (3.1 vs 2.0, p-value<0.001) and PhGA (delta of 0.273 between patients with and without feet involvement). These differences, anyway, do not lead to significant disease activity state changes.

Schieir et al (0532) compared early and sustained remission in men and women with early RA. SDAI remission was achieved similarly in men (64%) and women (61%), however women reached remission later (19.2 vs 16.1 months, p=0.03) and were less frequently reaching early (<12 months) and sustained remission (12-24 months) with respect to men.

Li et al (1402) compared the characteristics of 354 Late Onset (LORA) and 518 Younger Onset (YORA) RA patients. YORA patients were more commonly males (34% vs. 20% p<0.0001) and seronegative (37% vs. 25% p=0.0003). Compared to YORA, the hazard ratio for remission in LORA was 1.10 (CI 0.90-1.34 p=0.35). Among those reaching remission, less LORA patients were on a b/tsDMARD (16% vs. 27%) and more were on single csDMARD (34% vs. 27%) (chi2 p=0.0039).

Brooks et al (1647) evaluated lung cancer risk in RA by means of a large retrospective matched cohort study (4,526,619 patient-years). RA patients had a higher rate of lung cancer than non-RA (60.1 vs. 37.9 per 10,000 PY). RA was still associated with an increased risk of lung cancer after adjustment for confounders (aHR 1.53 [1.47,1.60]) and when limited to non-smokers (aHR 1.66 [1.24, 2.22]). RA-ILD bears an higher risk for lung cancer (aHR 3.06 [2.05, 4.57]) vs RA without ILD (aHR 1.53 [1.47, 1.59]).

Bricman et al (1394investigated the association between location of baseline joint swelling (44 joints) and disease characteristics in 435 early RA patients. Swelling in knee, elbow, shoulder, ankle, wrist, MCP3, IPP 1, 2 and MTP5 was highly associated with higher DAS28, while swelling of MCP1, 3, 4 and MTP 1,2, 5 was associated with erosive disease. Swelling of MTP1, 2, 5 was associated with the presence of ACPA. No difference was observed for smoking habits and gender. 

Khidir et al (1956) evaluated whether functional disabilities starting in hands or feet contribute to predicting progression to RA in a cohort of 600 clinically suspect arthralgia patients . Among the 99 patients who developed IA, hands-disabilities (assessed by HAQ), were reported earlier and were more severe than feet-disabilities (difference of 0.41 units, p< 0.001). A single question on difficulties with dressing was independently and equally predictive as total HAQ≥1 for IA-development (HR 2.3 (CI=1.5-3.6, p< 0.001).

About the Author

Emanuele Bozzalla Cassione


Emanuele is a consultant rheumatologist and PhD student in experimental medicine at IRCCS Policlinico San Matteo Foundation (Pavia, Italy). His focus is on rheumatoid arthritis and spondylarthritis He is elected member of the Italian Society of Rheumatology Young (SIRyoung) committee and EMEUNET Country Liaison Officer for Italy.

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