BIOLOGICAL DISORDERS ARE COMMON IN THE INITIAL ASSESSMENT OF RECENT ONSET POLYARTHRITIS BUT A CONTRA- INDICATION TO THE INTRODUCTION OF TREATMENT WITH METHOTREXATE (MTX) IS RARE. STUDY OF 3 COHORTS (ESPOIR, VERA AND BRITANY COHORT)

Background: Detection of renal insufficiency (RI), hepatitis and abnormalities of complete blood count (CBC) are classically recommended in early arthritis (ACR, EULAR, SFR) for diagnosis but also before introducing treatment like disease modifying drugs (DMARD) (Methotrexate (MTX), non-steroidal anti-inflammatory drug (NSAID)…). Threshold values are only specified in ACR recommendations (1). Objectives: To evaluate the prevalence of abnormalities of standard biological tests in early arthritis according to the inclusion criteria and the impact on DMARD prescription (MTX) (according to ACR) and/or NSAID. Methods: We evaluated the prevalence of anemia (Hb <13 g/dL for men and 12 g/dL for women), leucopenia (<3000 et <3500/mm), neutropenia (<1500/mm), thrombopenia (<150 000/mm), renal insufficiency (RI) severe (Clearance (Cl) <30 mL/min, moderate Cl: 30 à 59,9 mL/min and light Cl: 60 à 89,9 mL/min), liver cytolysis (ASAT and ALAT >N or 2 N), inflammatory reaction (VS>20 et CRP>6) in 3 cohorts: ESPOIR (age 18-70, more than 2 arthritis, >6 weeks duration but <6 months, no DMARD or steroids, included from 2002; n: 813 patients), VErA (more than 18 years old, >2 arthritis, >4 weeks and <6 months, included from 1998, n: 310) and Brittany cohort (BC) (age>18, >1 arthritis lasting for less than 1 year, included in 1995 and 1997, n: 270). Results: 1393 patients were evaluated. 26.5% of patients (ESPOIR: 29.6%, VErA: 16.6%, BC: 28.5%) had anemia (p≤0,0001). 1.3% of patients have leucopenia and 1,4% neutropenia, without significant difference between the cohort. 0.9% of patients had thrombocytopenia. 50.4% of patients have an increased ESR (ESPOIR 52%, VErA 43.8%, BC 53%) and 62.7% had increased CRP (ESPOIR 67%, VErA 53.8%, CB 60%) with a significant difference between cohorts (p=0.031 and p<0.001). 4.3%and 10% of patients had elevated AST and ALT> N. There is no patient with severe renal insufficiency at diagnosis. 5.5% of patients have a clearance between 30 and 60 mL/min (moderate RI) and 42.5% had a 60 to 90 mL/min (minimal RI). 32.6% of patients taking NSAID are anemic against 26.6% of those who did not (p=0,079). The cytolysis does not appear associated with NSAID use. Clinicians take account of renal function for their prescriptions because patients on NSAID have less often a moderate or light RI as untreated patients (5% vs 5.7% and 37.8% vs 46% respectively) (p=0048). Nevertheless, among the 1094 patients who had all the tests, only 18 [1.64% (95% CI: 1-2.64)] have a formal cons-indication to the prescription of MTX according to the ACR. Conclusions: It is common to screen for anemia in recent-onset arthritis, moderate and minimal renal impairment, and abnormal liver function. However, less than 2% of patients have a formal contra-indication to MTX according to the ACR. References: 1. Saag KG et al. Arthritis Rheum. 2008 Jun 15;59(6):762-84. Disclosure of Interest: None DeclaredCitation: Annals of the Rheumatic Diseases, volume 70, supplement 3, year 2011, page 584Session: Rheumatoid arthritis – comorbidity and clinical aspects (Poster Presentations )