Pos1360 Do Routine Radiographs of Hands and Feet in Patients With Clinically Suspect Arthralgia Have Diagnostic or Prognostic Value? A Large Longitudinal Study

Background: Traditionally, conventional radiographs of hands and feet in rheumatoid arthritis are used to depict structural joint damage. This is also commonly done in symptomatic patients at risk for RA (clinically suspect arthralgia (CSA)), however the rationale for this is questionable since the prevalence and implications of radiographic joint damage in this disease phase are unknown. Objectives: We therefore aimed to investigate the prevalence of radiographic joint damage in CSA and its progression over time. Methods: 749 symptomatic patients at risk for RA development from our observational CSA cohort were followed until development of inflammatory arthritis (IA) or during 2 years follow-up. Radiographs of hands and feet were conducted at maximum four points in time (baseline, 4, 12 and 24 months or upon development of IA). Radiographic joint damage of in total 1,494 radiographs was evaluated in three ways; erosive disease according to the radiologist, according to the Sharp van der Heijde Scoring method (SHS) and erosive disease specific for RA according to the EULAR/ACR 2010 RA-criteria. Prevalence and progression of radiographic joint damage were described during two years follow-up or until development of IA, for the total cohort and stratified for ACPA (anti-citrullinated protein antibody)-status. Progression of >5 SHS-points was considered as the minimal clinically important difference (MCID). The predictive value of baseline SHS for IA-development was analysed via Cox regression analyses adjusted for age. Results: According to the radiologist, 1.7% of patients had erosive disease at first presentation (Figure 1A). The median erosion SHS was 1 (interquartile range (IQR) 0-1) and similar for ACPA-positive and ACPA-negative patients (both 0 (0-1), p=0.45). 2.5% of patients had erosive disease as defined by the EULAR/ACR 2010 criteria (Figure 1B). Radiographic progression greater than the MCID was rare (4%) in CSA-patients (Figure 1C), regardless of ACPA-status or IA-development. Baseline SHS was not predictive for IA-development (hazard ratio 1.02 (95% confidence interval 0.97;1.07)), also not in ACPA-subgroups or when studying only SHS-erosion scores. Conclusion: At CSA-onset, radiographic erosions are rare. Erosion scores and SHS-scores are not predictive for IA development. Moreover, radiographic progression over time is scarce. Therefore, for clinical practice, routinely made radiographs such as in RA, can be omitted in the at-risk stage of CSA. Acknowledgements: NIL. Disclosure of Interests: None declared.