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POS1442 THE SUBGROUP OF ACPA-NEGATIVE RHEUMATOID ARTHRITIS PATIENTS ACHIEVING SUSTAINED DMARD-FREE REMISSION IS CHARACTERIZED BY A DIFFERENT RESPONSE IN SEROLOGICAL MARKERS WITHIN THE FIRST YEAR OF DMARD-INITIATION

Whilst ~40% of ACPA-negative RA-patients achieve sustained DMARD-free remission (SDFR; the sustained absence of synovitis after DMARD-cessation), the biological pathways involved in SDFR-development are incompletely understood. Previously, high baseline levels of MMP-3, SAA and CRP were found in ACPA-negative RA-patients achieving SDFR. Differences in biomarker levels might reflect distinct underlying biological pathways leading towards disease resolution in this subgroup of ACPA-negative RA-patients. Subsequently, the course of specific biomarkers after treatment-initiation could attain more insight in the understanding of SDFR-development in ACPA-negative RA.We explored whether the response of specific biomarkers after treatment-initiation could increase the understanding of SDFR-development in ACPA-negative RA.One-hundred-thirty-one consecutive ACPA-negative RA-patients were studied on SDFR-development during (median) 7.2-years follow-up. Twelve biomarkers (SAA/CRP/MMP-1/MMP-3/resistin/leptin/IL-6/TNF-R1/YKL-40/EGF/VEGF/VCAM-1) were measured at diagnosis and 1-, and 2-years after DMARD-initiation and compared between patients achieving and not achieving SDFR. To extend on previous findings on baseline levels, correlations between baseline levels and change in levels within year-1 were determined using spearman’s rho (ρ).RA-patients that achieved SDFR (n=63) were characterized by a stronger decline in MMP-1, MMP-3, SAA and CRP in the first 12-months after DMARD-start, compared to RA-patients not achieving SDFR. MMP-1 and MMP-3 declined 1.30-times (95%CI; 1.08-1.57) and 1.44-times (95%CI; 1.00-2.06) stronger in SDFR-patients. In SAA and CRP, this decline was 2.12-times (95%CI; 1.08-4.14) and 2.24-times (95%CI; 1.16-4.35) stronger. Baseline levels of MMP-3, SAA and CRP and strongly correlated with decline in 12-months; ρ -0.6991, ρ -0.9205 respectively ρ -0.9008. RA-patients with high baseline levels characterized the subgroup with the strongest decline in biomarker levels in the first year after DMARD-initiation.The subgroup ACPA-negative RA-patients achieving SDFR are characterized by higher baseline levels and a stronger serological response of MMP-3, SAA and CRP after DMARD-initiation. Because MMP-3 and SAA are expressed by fibroblast-like synoviocytes, these cells may differ in RA-patients achieving disease resolution; molecular studies on synovial tissue could be a next step.None declared