LAUSR

Background Rheumatoid Arthritis (RA) is a chronic inflammatory joint disease affecting approx. 1% of the adult population of Northern Europe. Strategies for its early detection and diagnosis are of high importance as prompt treatment improves clinical and structural outcome. Formation of autoantibodies against cyclic citrullinated proteins (anti-CCP) are identified to be associated to RA-development. Non-specific musculoskeletal (nsMSK) pain often precedes early RA-development. Often, patients with initial symptoms are referred to General Practitioners (GP) without access to a sensitive rheumatologic assessment. Objectives To evaluate incidence of patients with positivity in anti-CCP rapid-test and signs and symptoms of subclinical and clinical inflammation in a on risk-population for RA. Methods In this prospective study (PANORA), 980 patients with new onset of nsMSK pain at GP were included in 77 GP sites in Germany. In case of positivity in anti-CCP rapid-test (CCPoint®), patients were referred to Rheumatology Department (RD) for assessment and RA-evaluation. At RD, validation of anti-CCP testing (using ELISA) and a rheumatological examination including ultrasound was performed. Subclinical signs of inflammation defined as increase of microvascularisation were monitored by Fluorescence-optical imaging (FOI). In case of ELISA positivity but missing clinical evidence of RA, patients are monitored every 6 months for a total follow-up of 36 months or until RA-diagnosis. Results Data from 980 patients with completion of visits at GP and/or RD was analyzed from which 9.8% (n=94) of the patients showed a positive anti-CCP rapid-test at GP. At RD, 21% (n=25) of the rapid-test positive patients were confirmed anti-CCP-positive by ELISA. 10 patients were diagnosed with RA (1 in the ELISA negative group), thereof one case of a newly detected RA at month 6 of the follow-up period. In the three groups at baseline (figure 1), age was well balanced, the proportion of female patients was highest in the RA-diagnosis cohort (80%) as well as the proportion of patient with current or past smoking-status (40% vs. 22.2% in the RA-/ELISA- group). Conclusion Here, for the first time data from patients suspect for RA development (non-specific musculoskeletal pain within the last 6 months) and screened using anti-CCP point-of-care test at GP are reported. Within the group re-evaluated at RD due to positive point-of-care test, only 21% were confirmed positive using ELISA testing. In the screened population, already 10 patients were diagnosed as RA at RD including 1 patient in the follow-up period until now. The continuation of the PANORA patients in the follow-up period will give more insights in specific characteristics of the RA-risk population at early stages of the disease when combining serological and imaging markers using ultrasound and FOI.Figure 1 Study Flow Chart Disclosure of Interests Michaela Koehm Grant/research support from: BMS, Pfizer, Janssen, Consultant for: Pfizer, Celgene, Janssen, Speakers bureau: Pfizer, Celgene, Janssen, Ulf Henkemeier Grant/research support from: BMS, Tanja Rossmanith Grant/research support from: BMS, Pfizer, Janssen, Karola Mergenthal: None declared, Juliana J. Petersen: None declared, Harald Burkhardt Grant/research support from: BMS, Pfizer, Janssen, Consultant for: AbbVie, BMS, Pfizer, Janssen, Roche, Chugai, Speakers bureau: AbbVie, BMS, Pfizer, Janssen, Roche, Chugai, Frank Behrens Grant/research support from: AbbVie, Pfizer, Roche, Chugai, Prophylix, Bioline, Novartis, Consultant for: AbbVie, Pfizer, Roche, Chugai, UCB, Bristol-Myers Squibb, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Eli Lilly, Speakers bureau: Ad board: AbbVie, Pfizer, Roche, Chugai, UCB, Bristol-Myers Squibb, Celgene, Novartis, Biotest, Janssen, Genzyme, Eli Lilly