gms | German Medical Science

Introduction: Strategies for the early detection and diagnosis of Rheumatoid Arthritis (RA) are of high importance as prompt treatment improves clinical and structural outcome. Autoantibodies against cyclic citrullinated proteins (anti-CCP) have been associated with RA-development. Non-specific musculoskeletal (nsMSK) symptoms are often described prior to RA development. Studies of early arthritis cohorts have shown that a large number of early arthritis patients cannot be accurately diagnosed at their first visit, and are often referred as undifferentiated arthritis patients.

Methods: In this prospective study (PANORA), 978 patients with new onset of nsMSK symptoms were included in 77 GP sites in Germany. Patients with a positive anti-CCP rapid-test (CCPoint^®) were referred to Rheumatology Department (RD) for rheumatological assessment, RA-evaluation and an anti-CCP validation test (ELISA). ELISA anti-CCP positive patients without RA were monitored every 6 months for a total follow-up of 36 months or until RA-diagnosis. Patients with a negative anti-CPP result (CCPoint^® or ELISA) are followed up with a questionnaire after 1 and 3 years.

Results: From 978 included patients, 105 (10.7%) were anti-CCP positive (CCPoint^®). Of these, 96 were tested with ELISA and 27 (28.1%) were confirmed anti-CCP positive. 9 (33.3%) of these patients were diagnosed with RA at the first RD visit; 4 further patients were diagnosed with RA during the follow-up (FU) period so far. Overall, 48.1% of ELISA-positive (ELISA+) patients were diagnosed with RA up to now; 11 ELISA+ patients are still in the FU period of the study. Of the 868 CCPoint^® negative patients, currently, 282 have filled out a 1-year FU questionnaire; 3.5% of those reported a RA diagnosis (Table 1 [Tab. 1]).

Conclusion: Currently, 48.1% of anti-CCP+ (ELISA) patients have received a RA diagnosis, whereas 3.5% of the anti-CCP- (CCPoint^®) received a RA diagnosis (patient reported), which underlines, that anti-CCP can be used as a marker to identify high-risk patients in GP setting. While clinical parameters are correlated with the diagnosis of RA, they are not suited for predicting future RA development alone. Anti-CCP, possibly in combination with additional parameters such as imaging, might increase the likelihood to early diagnose or predict RA development.

Figure 1 [Fig. 1]

Disclosures: Stephanie Dauth Grant/research support from: BMS; Michaela Koehm Grant/research support from: BMS, Pfizer, Janssen, Consultant for: Pfizer, Celgene, Janssen, Speakers bureau: Pfizer, Celgene, Janssen; Timm Oberwahrenbrock Grant/research support from: BMS; 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