ANTI-CARBAMYLATED ANTIBODIES ARE ASSOCIATED WITH TOBACCO AND POOR OUTCOMES IN RHEUMATOID ARTHRITIS

Background: Anti-carbamylated protein antibodies (Anti-CarP) represent a novel autoantibody family present in sera of patients with rheumatoid arthritis (RA) with high specificity. Objectives: To analyse the prevalence of Anti-CarP in an established RA cohort and evaluate their association with the presence of other autoantibodies and disease activity and severity. Methods: Cross-sectional study. Presence of Anti-CarP was analyzed in a cohort of patients with established RA (n: 158) by a home-made ELISA test using fetal calf serum. We investigated the demographic, radiological and current and at disease onset clinical features. Rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA) status were also assessed. Results: Anti-CarP were positive in 46.2% of the patients in our cohort and in 15.1%, 19.2% and 9.1% of the patients negative for ACPA, RF and both respectively. Demographic and clinical features are shown in table 1 . The mean titer of ACPA (1361±1054 U/mL vs. 918 ± 1092 U/mL) and RF (258 ± 255 AU vs. 174 ± 205 AU) were significantly higher in Anti-CarP positive patients. No difference in symptoms at RA onset was observed. Current (24.7% vs. 11.8%) and previous (54.8% vs. 37.6%) smoking consumption were significantly associated with Anti-CarP antibodies. Anti-CarP positive patients presented a higher CRP values (1. 0±1.6 mg/dL vs. 0.5 ±0.8 mg/dL), swollen joint count (1.3±2.2 vs 0.7 ±1.8) and patient global health assessment VAS (34.8 ±21.5 mm vs. 26.4 ±17.1 mm); although no between-group differences in disease activity (DAS28, CDAI, SDAI and RAPID3) or demographic features were observed. Anti-CarP positive patients presented significant higher scores in Larsen index (23.6 ± 15.7 vs. 15.7 ± 12.6) and disability (HAQ-DI >1) (23.3% vs. 8.3%). Conclusion: Anti-CarP were present in approximately half of the RA cohort and were also detected in seronegative (RF and/or ACPA) patients. In our cohort, patients with Anti-CarP antibodies presented higher tobacco consumption and poorer disease outcomes. Table 1 Demographic and Clinical Features According to Anti-CarP Status Anti-CarP positive n: 73 Anti-CarP negative n: 85 Female 52 (71.2%) 71 (83.5%) Mean age at diagnosis (SD) 53.6 (±11.9) 53.8 (±14.4) Mean age at inclusion (SD) 58.7 (±11.9) 58.9 (±14.1) Extra-articular manifestations 21 (28.8%) 15 (17.6%) Disease duration (SD) 5.1 (±2.7) 5.0 (±2.7) Smoking history· Previous and/or current· Current 40 (54.8%)18 (24.7%) 32 (37.6%) *10 (11.8%) * RA family history 12 (16.4%) 10(11.8%) BMI 27.5 (±4.5) 27.1 (±5) Disease presentation at initiation (%)· Palindromic rheumatism· Inflammatory arthralgia· Pseudopolymyalgia· Polyarticular arthritis 15 (20.5%)7 (9.6%)4 (5.5%)47 (64.4%) 14 (16.5%)6 (7.1%)1 (1.2%)64 (75.3%) Mean DAS28 (SD):· Remission/Low 3.0 (±1.3)65.8% 2.8 (±1.2)68.2% Mean DAS28 PCR (SD);· Remission/Low 2.7 (±1.2)72.6% 2.4 (±1.1)80.0% Mean CDAI (SD);· Remission/Low 9.2 (±8.2)71.2% 7.2 (±6.5)80.0% Mean SDAI (SD);· Remission/Low 10.2 (±8.6)68.5% 7.8 (±6.9)77.6% Mean RAPID3 (SD):· Remission/Low 10.2 (±8.6)47.2% 7.8 (±6.9)48.2% Mean HAQ (SD)Poor HAQ (>1) 0.45 (±0.52)17 (23.3%) 0.29 (±0.39)7 (8.3%) ** Pain Analogue Scale mm (SD) 27.6 (±29.8) 20.6 (±22.7) Treatment:· Glucocorticoids· cDMARDs · MTX · HCQ · LEF· bDMARDs 44 (61.1%)63 (86.3%)48 (65.8%)7 (9.6%)14 (19.2%)17 (23.3%) 49 (57.6%)71 (83.5%)56 (65.9%)12 (14.1%)14 (16.5%)32 (24.8%) Erosive disease 37 (50.7%) 46 (54.8%) Modified Larsen Score 23.6 (±15.7) 15.7 (±12.6) ** Disclosure of Interests: Raul Castellanos-Moreira Speakers bureau: For Lilly and Merk Sharp and Dohme, Sebastian C Rodriguez-García: None declared, Virginia Ruiz: None declared, Oscar Camacho: None declared, Julio Ramirez: None declared, Andrea Cuervo: None declared, Cristina Garcia-Moreno: None declared, Rosa Morla: None declared, José Gomez Puerta Speakers bureau: BMS, Pfizer, Amgen, Juan D. Cañete: None declared, Isabel Haro: None declared, Raimón Sanmartí Speakers bureau: PFIZER, SANOFI, LILLY, MSD, UCB, NOVARTIS, JANSSEN DOI: 10.1136/annrheumdis-2019-eular.6240Citation: Ann Rheum Dis, volume 78, supplement 2, year 2019, page A302Session: Rheumatoid arthritis - prognosis, predictors and outcome (Scientific Abstracts)