SAT0053 The incident immunological status predicts drug-free disease flare in rheumatoid arthritis patients achieving stringent clinical and ultrasonographic control of the peripheral inflammatory process

Background The development of predictive tools to evaluate health risks and design personalized health plans in patients with rheumatoid arthritis (RA) achieving remission still represents a major unmet need. In this perspective, the relative weight of clinical, ultrasound and immunological assessment of disease characteristics for predicting recurrence of the inflammatory process under drug-free conditions remains unclear. Objectives To investigate the predictive value of baseline clinical remission stringency, synovial power Doppler (PD) ultrasound indices and the incident autoimmune status, as predictors of flare under drug-free conditions after a DAS28-driven treatment strategy with methotrexate (MTX) in early RA. Methods 85 RA patients achieving stable remission and candidate to MTX withdrawal were recruited according to the following criteria: 1) introduction of MTX within 12 months from symptoms9 onset, 2) at least 24 months of MTX treatment with a DAS28-driven protocol targeting low disease activity (LDA), 3) DAS28 Results At baseline, 84% of the patients were in remission according to the SDAI ( Conclusions The systemic immuno-type of patients in remission is the major determinant of drug-free disease recurrence, over and above drug-induced achievement of stringent clinical and ultrasonographic control of the peripheral inflammatory process. References Meeuwisse CM et al. Identification of CXCL13 as a marker for rheumatoid arthritis outcome using an in silico model of the rheumatic joint. Arthritis Rheum 2011; 63: 1265–73. Havenar-Daughton C et al. CXCL13 is a plasma biomarker of germinal center activity. Proc Natl Acad Sci U S A 2016; 113: 2702–7. Disclosure of Interest None declared