Article Text
Abstract
Objectives Recent studies suggest that implementation of the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis (RA) leads to higher inflammatory activity in seronegative compared with seropositive patients at time of diagnosis. Our aim was to compare the disease course in seronegative and seropositive patients classified according to the 2010 criteria.
Methods DMARD-naïve patients with RA fulfilling the 2010 criteria were included in the treat-to-target ARCTIC trial and followed for 24 months. We stratified patients as seropositive (rheumatoid factor (RF)+, anticitrullinated protein antibodies (ACPA)+ or both) or seronegative (RF– and ACPA–) and compared disease activity, radiographic progression, treatment response and remission rates across groups.
Results 230 patients were included with mean (SD) age 51.4 (13.7) years, and 61% were female. 34 patients (15%) were seronegative. At 24 months, disease activity measures, radiographic progression and remission rates were similar between groups, despite more inflammatory activity in seronegative patients at baseline. Treatment response was slower in seronegative compared with seropositive patients. The groups received similar treatment.
Conclusion Our findings suggest that among patients with RA classified according to the 2010 ACR/EULAR criteria, seronegative patients respond well to modern treatment strategies. However, treatment response was somewhat slower in seronegative patients and radiographic progression was similar in seronegative and seropositive patients. Our results indicate that seronegative RA is not a mild form of the disease and requires intensive treat-to-target therapy similar to treatment of seropositive RA.
- anti-CCP
- early rheumatoid arthritis
- epidemiology
- rheumatoid arthritis
- rheumatoid factor
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Footnotes
Presented at Some of the findings in this article were presented as a poster presentation at the EULAR and ACR 2017 annual meetings.
Contributors All authors were involved in drafting the article or revising it critically for important intellectual content and approved the final manuscript to be submitted and agreed to be accountable for all aspects of the work. Conception and design of the study: EAH, SL, LBN, A-BA, EL, ICO, HBH, TU, DvdH, JS and TKK. Acquisition of data: EAH, A-BA, HBH, TU and the ARCTIC investigators. Analysis and interpretation of data: LBN, ICO, JS, EAH, SL, EL, A-BA, DvdH and TKK.
Funding The study has received grants from the Norwegian Research Council, the South-East Health Region in Norway, The Norwegian Rheumatism Association and unrestricted grant support from AbbVie, Pfizer, MSD, Roche and UCB.
Competing interests EAH has received research funding from Pfizer, UCB, Roche, MSD and AbbVie for the submitted work, honorariums as a speaker from Pfizer, UCB, Roche and AbbVie and honorariums for development of educational material from Pfizer and Eli Lilly and has sat on advisory boards for Pfizer, Eli Lilly, Celgene and Janssen-Cilag. A-BA has sat on advisory boards for UCB, AbbVie and Pfizer and received honorariums for development of educational material for UCB. HBH has received honorariums as a speaker from AbbVie, Bristol-Myers Squibb, Roche, UCB Pharma, Novartis and Pfizer. DvdH has received consultancy honorariums from AbbVie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Celgene, Daiichi, Eli Lilly, Galapagos, Merck, Novartis, Pfizer, Roche, Sanofi Aventis, Janssen and UCB and is owner of Imaging Rheumatology. TKK has received consultancy honorariums from AbbVie, Bristol-Myers Squibb, Celltrion, Epirus, Hospira, Merck-Serono, MSD, Orion Pharma, Pfizer, Roche and UCB. TU has received honorariums as a speaker from AbbVie, Bristol-Myers Squibb, Lilly, Roche, Novartis, UCB Pharma and Pfizer. ICO has received consultancy honorarium from Pfizer.
Patient consent Not required.
Ethics approval The Norwegian Regional ethics committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The authors commit to making the relevant anonymised patient level data available on reasonable request.