POS0452 SYNOVIAL MYELOID-STROMAL PATHOTYPE PREDICTS ONE-YEAR RADIOGRAPHIC PROGRESSION IN ACTIVE RHEUMATOID ARTHRITIS

Background: Rheumatoid arthritis (RA) is a heterogeneous disease with variable prognosis. The cellular composition in synovium the driving force of joint destruction RA, and predictive values histopathological assessments on clinical outcomes RA have been identified. However, current synovial mainly focus infiltrated immunocytes to distinguish into different pathotypes. Whether addition stromal cells improve accuracy remains unknow. Objectives: To pathotypes based intercellular connection explore their value one-year radiographic progression. Methods: Active patients who underwent needle biopsy at baseline were recruited from real-world prospective cohort. Clinical data evaluated 1, 3, 6, 12 months. Histopathologic included Krenn synovitis score semiquantitative immunohistochemical staining for CD20, CD38, CD4, CD8, CD68, CD31 CD90. Cluster analysis was used primary outcome progression defined as change total Sharp/van der Heijde modified score≥0.5 units. Results: 1. Among 134 received finished follow-up, 105 had qualified tissue. mean age 50.2±13.3 years 77.1% female. median duration 24 (9-120) All active 64.8%, 26.7% 8.6% high, moderate low activity, respectively. There 41 (39%) never treated corticosteroids or disease-modifying anti-rheumatic drugs. 2. During there 48.6%, 63.8%, 71.4%, 69.5% achieved CDAI LDA target, 12.4%, 30.5%, 34.3%, 32.4% remission after months, A 33 (31.4%) 3. divided three clusters using cluster seven scores. Patients 1 ( n =50, 47.6%) higher scores sublining CD68+ macrophages, CD31+ endothelial CD90+ fibroblasts, thus named myeloid-stromal pathotype. 2 =26, 24.8%) CD20+ B cells, CD38+ plasma CD4+ T CD8+ lymphoid 3 =29, 27.6%) lower all cell types, pauci-cellular pathotype (Figure 1). 4. showed rate versus (48% vs. 16.4%, P <0.001), whereas no difference between (11.5% 20.7, =0.475). Adjusted confounding factors including age, sex, smoking, duration, RF status, ACPA CDAI, HAQ-DI mTSS baseline, multivariate logistic regression that independently predicted AOR =3.602, 95%CI:1.257-10.324, =0.017, Table Conclusion: Baseline can predict Funding: This work supported by National Natural Science Foundation China (no. 81971527, 81801606 81801605), Guangdong 2018A030313541 2018A030313690), Medical Scientific Research A2018062), Basic Applied 2019A1515011928 2020A1515110061), Technology Program Guangzhou 201904010088). Acknowledgements: We thank subjects medical staff generously contributed this study. Disclosure Interests: None declared