ORLANDO — Among patients with rheumatoid arthritis, the presence of serum anti-citrullinated protein antibodies with erosive disease is a predictor of high health care use, according to data presented at the 2019 Rheumatology Nurses Society Annual Conference.

“What we wanted to find out was whether patients with RA who were anti-cyclic citrullinated peptide (anti-CCP) positive, with erosions or without erosions, had a difference in health care utilization, specifically looking at all-cause hospitalization and the use of assistive devices,” Shancey Young, FNP-C, MSL, medical science liaison for Bristol-Myers Squibb, told Healio Rheumatology. “That can include a special fork to help pick up their food, or crutches or wheelchairs. We also looked at radiographic imaging that they have to have done, as well as joint surgery.”

To determine and compare the rates of health care use among patients with RA who were anti-CCP positive — determined to be a surrogate for anti-citrullinated protein antibodies — either with or without erosions, Young and colleagues studied data from the Corrona RA registry. According to the researchers, the Corrona registry is an independent, prospective, national observational cohort of, as of June 2018, approximately 49,162 patients with RA from 117 private practices and academic facilities across 42 states.

The researchers analyzed 2,047 adult patients with RA enrolled in the registry between October 2001 and August 2017, who had initiated a biologic DMARD and were anti-CCP positive prior to DMARD initiation. Additionally, the researchers narrowed their scope to patients with a 12-month follow-up visit. The researchers determined health care use during the 12-month period following the initiation visit, including all-cause hospitalizations, all-site joint surgeries, radiographic procedures and assistive devices. Outcomes were assessed using physician and laboratory follow-up forms.

Image of arthritic hand

Among patients with RA, the presence of serum anti-citrullinated protein antibodies with erosive disease is a predictor of high health care use, according to data.
Source: Adobe

According to the researchers, 868 included patients had erosions, as measured by radiology, and 1,179 did not. Baseline characteristics were generally balanced between the two groups, except that those with erosions demonstrated longer RA duration and higher prior conventional synthetic, targeted synthetic and biologic DMARD use, compared with those without.

During the 12-month follow-up period, rates of health care use were higher among patients with erosions, compared with those without, across all biologic DMARDs. According to Young, patients with erosions had significant increases in all-cause hospitalization, radiographic imaging and use of assistive devices. She added that these findings suggest that early treatment, prior to the formation of erosions, could potentially improve outcomes in patients with RA who are anti-CCP positive.

“If we could treat these patients earlier, before they get erosions, from what we are showing in this data, it would appear that we could not only save insurance companies and the patient money on hospitalization, assistive devices and radiographic imaging, but we could also prevent them from potentially ever needing these items,” Young said. “Also, not just specifically money but also the patient’s quality of life would be improved by not having these hospitalizations and surgeries.” – by Jason Laday

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