P211 Indirect measurement of central sensitisation as a predictor of response to different drug treatments in patients with inflammatory arthritis in a UK clinical cohort

Abstract Background Rheumatoid arthritis (RA) is a common, painful and disabling condition. Despite effective treatment of inflammation, many patients continue to experience ongoing pain. Central sensitisation could explain this apparent discordance, but at current is not routinely assessed in clinical practice. Previous studies have used the non-inflammatory components of Disease Activity Score-28 (DAS28-CRP) to derive novel, indirect indicators of central sensitisation. The aim of this study was to investigate whether DAS28-derived indices could be used to predict response to drug therapy in a clinical dataset. Methods This retrospective observational cohort study of patients with RA used NHS data collected prospectively from February 2016 to June 2018 from the Rheumatology Assessment Database in Oxford (Rhadio). The study received necessary ethical clearance from the NHS Health Research Authority (IRAS number: 246029). Baseline clinical and demographic data were extracted the following potential indirect indicators of centrally mediated pain were calculated: tender-swollen joint count difference (TJC-SJC difference), swollen to tender joint count ratio (STR), and DAS28-P, a measure of the non-inflammatory proportion of DAS28-CRP. The DAS28-P measure used herein includes CRP rather than ESR and is multiplied by 100 for ease of interpretation. Individual disease outcomes at follow-up were calculated according to European League Against Rheumatism (EULAR) criteria and multivariate logistic regression models including age, gender, treatment duration and drug regimens were generated to assess the relationship between potential baseline pain indicators and EULAR outcome at follow-up. Results We included data from 2,176 patients with RA.The majority were female (71.4%) with a median age of 64.8 (IQR= 53.6 to 73.3) years. The largest proportion of patients were classified as being in clinical remission at baseline, though there was considerable heterogeneity in the symptomatic profiles of patients within any given disease activity classification. 872 patients had valid follow-up data at ≥ three months post-baseline visit. Patients undergoing treatment escalation had significantly decreased DAS28-P scores at ≥ three months follow-up compared to baseline, while no significant change was observed in patients on stable therapy. Regression analyses showed that the three indirect indices of central sensitisation were positive predictors of treatment outcome. A unit increase in any one of TJC-SJC difference, STR or DAS28-P at baseline significantly increased the odds of a patient achieving at least a moderate EULAR response at follow-up, even when confounding factors were controlled for (DAS28-P: OR = 1.062 (95% CI: 1.050, 1.075) p < 0.0005; STR: OR = 2.746 (95% CI: 1.466, 5.146) p = 0.002; TJC-SJC difference: OR = 1.101 (95% CI: 1.055, 1.150) p < 0.0005). Conclusion The overall DAS28-CRP score is sensitive to fluctuations of different disease components including inflammation, pain and general health. Novel DAS28-CRP-derived indices can highlight the frequently observed discordance between the inflammatory and non-inflammatory components of the DAS28-CRP score. Disclosures S. Santos-Paulo None. A.R. Segerdahl None. S. Hawley None. R.A. Luqmani None. I. Tracey None. A. Soni None.

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Trajectories of fatigue in actively treated patients with established rheumatoid arthritis starting biologic DMARD therapy

RMD Open ◽

10.1136/rmdopen-2020-001372 ◽

2020 ◽

Vol 6 (3) ◽

pp. e001372

Author(s):

Sella Aarrestad Provan ◽

Brigitte Michelsen ◽

Joseph Sexton ◽

Tillmann Uhlig ◽

Hilde Berner Hammer

Keyword(s):

Rheumatoid Arthritis ◽

Rating Scale ◽

Numeric Rating Scale ◽

Tender Joint Count ◽

Tender Joint ◽

Logistic Regression Models ◽

Patient Reported ◽

Biologic Dmard ◽

Clinically Significant

ObjectivesTo define fatigue trajectories in patients with rheumatoid arthritis (RA) who initiate biological DMARD (bDMARD) treatment, and explore baseline predictors for a trajectory of continued fatigue.MethodsOne-hundred and eighty-four patients with RA initiating bDMARDs were assessed at 0, 1, 2, 3, 6 and 12 months. Swollen and tender joint counts, patient reported outcomes (PROMs), blood samples and ultrasound examinations were collected at each time point. Fatigue was assessed by the fatigue Numeric Rating Scale (0–10) from the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire. Clinically significant fatigue was predefined as fatigue ≥4. Three trajectories of interest were defined according to level of RAID fatigue: no fatigue (≤3 at 5/6 visits), improved fatigue (≥4 at start, but ≤3 at follow-up) and continued fatigue (≥4 at 5/6 visits). Baseline variables were compared between groups by bivariate analyses, and logistic regression models were used to explore baseline predictors of continued vs improved fatigue.ResultsThe majority of patients starting bDMARD therapy followed one of three fatigue trajectories, (no fatigue; n=61, improved; n=33 and continued fatigue; n=53). Patients with continued fatigue were more likely to be anti–citrullinated protein antibody and/or rheumatoid factor positive and had higher baseline PROMs compared to the other groups, while there were no differences between the groups for variables of inflammation including. Patient global, tender joint count and anxiety were predictors for the continued fatigue trajectory.DiscussionA trajectory of continued fatigue was determined by PROMs and not by inflammatory RA disease activity.

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POS0634 DO BIOLOGICS IMPROVE FATIGUE IN PATIENTS WITH RHEUMATOID ARTHRITIS?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3351 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 555.1-555

Author(s):

A. Fazaa ◽

H. Boussaa ◽

K. Ouenniche ◽

S. Miladi ◽

M. Sellami ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Demographic Data ◽

Tender Joint Count ◽

P Value ◽

Tender Joint ◽

Direct Role ◽

The Mean ◽

Disease Modifying ◽

Improve Fatigue

Background:Fatigue is a significant issue in rheumatoid arthritis (RA) with no accepted evidence-based management guidelines. Several studies suggested that biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs) have a direct role on fatigue in RA.Objectives:This study aimed to compare fatigue between patients treated with bDMARDs and conventional synthetic Disease Modifying Anti-Rheumatic Drugs (cs DMARDs).Methods:We conducted a longitudinal study including patients with RA (ACR/EULAR 2010). Patients with other acute or chronic diseases that may induce fatigue (such as cancer, infection or depression) were excluded. Demographic data and the following disease-related parameters were collected: pain Visual Analog Scale (VAS), Global Patient Assessment (GPA), tender joint count (TJC), swollen joint count (SJC), Erythrocyte Sedimentation Rate (ESR), C Protein Reactive (CRP), Disease Activity Score 28 (DAS28), Health Assessment Questionnaire (HAQ) and DMARDs used. Fatigue was assessed at baseline (T0), at 6 months (T6) and at 12months (T12) using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) which is a short 13-item questionnaire validated in RA. The score FACIT-F ranges between 0 and 52. Fatigue was considered mild if the FACIT-F score was ≥40, moderate if 20≤FACIT-F<40 and severe if 0≤FACIT-F<20. A p value inferior to 0.05 was considered significant.Results:We included 100 RA patients (84 women and 16 men) with a mean age of 49.5±10 years old [18-65]. The mean disease duration was 87.3 months [1-360]. The mean pain VAS was 49 cm [0-100] and the mean GPA was 47.8 cm [0-100]. The mean TJC and SJC were 5.3 [0-36] and 1 [0-9] respectively. The mean levels of ESR and CRP were 38.1 mm [10-120] and 10.8 mg/l [2-61] respectively. The mean DAS28 ESR was 3.68 [1.90-8.33] and the mean HAQ score was 0.90 [0-2.75].Eighty-three percent of patients used csDMARDs: Methotrexate (n=96), sulphasalazine (n=28), leflunomide (n=21), and hydroxychloroquine (n=12). bDMARDs were prescribed in 17% of patients: Rituximab (n=10), Infliximab (n=9), and Etanercept (n=5).At baseline, the mean FACIT-F score was 27.1 [0-51]. Moderate fatigue was noted in 57% of cases and severe fatigue in 26% of cases. Patients on csDMARDs had a lower FACIT-F score when compared to patients on bDMARDs (26.89 versus 28.41), but the difference was not statistically significant (p=0.630).The mean FACIT-F score was 27.41 in bDMARDs patients versus 29.80 in csDMARDs patients (p=0.497) at T6, and 32.35 versus 33.65 respectively at T12 (p=0.695).The mean delta FACIT-F was 2.18 in bDMARDs patiens versus 2.73 in csDMARDs patients between T6 and T0 (p=0.815), and 3.94 versus 7.2 respectively between T12 and T0 (p=0.807).When considering all patients, a significant positive correlation was noted between delta FACIT-F and delta DAS28 at T6 (r=0.418, p<0.001) and at T12 (r=0.338, p<0.001).Conclusion:RA patients treated with bDMARDs didn’t show significant improvement of fatigue in comparison with those treated with csDMARDs. Further studies are needed to determine if biologics improve fatigue, and whether the improvement results from a direct action on fatigue or indirectly through reduction in disease activity.Disclosure of Interests:None declared

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AB0174 FATIGUE IN RHEUMATOID ARTHRITIS: A CASE-CONTROL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3339 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1113.2-1113

Author(s):

A. Fazaa ◽

H. Boussaa ◽

K. Ouenniche ◽

S. Miladi ◽

M. Sellami ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Demographic Data ◽

Tender Joint Count ◽

P Value ◽

Common Symptom ◽

Healthy Controls ◽

Tender Joint ◽

Cross Sectional ◽

The Mean

Background:Fatigue is a common symptom in many chronic inflammatory diseases, including rheumatoid arthritis (RA). It is considered one of the most frustrating, uncontrollable, and overwhelming symptoms. However, most of rheumatologists do not assess fatigue despite its clinical significance and its impact on patients’ lives.Objectives:The aims of this study were to determine whether RA patients express more fatigue than healthy controls, and to analyze its correlation with disease activity.Methods:We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010) and healthy controls matched for sex and age. Patients with other acute or chronic diseases that may induce fatigue (such as cancer, infection or depression) were excluded. Demographic data and the following clinical parameters were collected: pain Visual Analog Scale (VAS), Global Patient Assessment (GPA), tender joint count (TJC) and swollen joint count (SJC), Erythrocyte Sedimentation Rate (ESR), C Protein Reactive (CRP), Disease Activity Score 28 (DAS28), and Health Assessment Questionnaire (HAQ). Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) which is a short 13-item questionnaire validated in RA. The score FACIT-F ranges between 0 and 52. Fatigue was considered mild if the FACIT-F score was ≥40, moderate if 20≤FACIT-F<40 and severe if 0≤FACIT-F<20. A p value inferior to 0.05 was considered significant.Results:We included 100 RA patients (84 women and 16 men) with a mean age of 49.5±10 years old [18-65]. The mean disease duration was 87.3 months [1-360]. The mean pain VAS was 49 cm [0-100] and the mean GPA was 47.8 cm [0-100]. The mean TJC and SJC were 5.3 [0-36] and 1 [0-9] respectively. The mean levels of ESR and CRP were 38.1 mm [10-120] and 10.8 mg/l [2-61] respectively. The mean DAS28 ESR was 3.68 [1.90-8.33] and the mean HAQ score was 0.90 [0-2.75].Thirty-nine healthy controls were enrolled including 35 women and 4 men with a mean age of 51.2 years old [30-64].The mean FACIT-F score was 27.1 [0-51] in RA patients versus 46.2 [0-52] in healthy controls (p<0.001). Among RA patients, 57% had moderate fatigue and 26% had severe fatigue.A significant negative correlation was noted between the FACIT-F score and the following parameters in RA patients: TJC (r=-0.568, p<0.001), SJC (r=-0.274, p<0.001), pain VAS (r=-0.605, p<0.001), GPA (r=-0.658, p<0.001), ESR (r=-0.405, p<0.001), CRP (r=-0.149, p<0.001), DAS28 (r=-0.837, p<0.001) and HAQ (r=-0.634, p<0.001).Conclusion:Fatigue was significantly more observed in RA patients. This symptom was correlated with disease activity and disability. It is important to recognize and manage fatigue in order to improve patients’ quality of life.Disclosure of Interests:None declared

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The Effect of Socioeconomic Class and Immigrant Status on Disease Activity in Rheumatoid Arthritis: Data from BARFOT, a Multi-Centre Study of Early RA

The Open Rheumatology Journal ◽

10.2174/1874312901307010105 ◽

2013 ◽

Vol 7 (1) ◽

pp. 105-111 ◽

Cited By ~ 4

Author(s):

Maria L.E. Andersson ◽

Stefan Bergman ◽

Maria K. Söderlin

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Tender Joint Count ◽

Immigrant Status ◽

Tender Joint ◽

Eular Response ◽

Multi Centre Study ◽

Socioeconomic Class ◽

Early Ra

Background:There have been no reports on the effect of immigrant status and socioeconomic status on outcome in rheumatoid arthritis (RA) in Sweden.Methods:Between 1992 and 2006, 2,800 patients were included in the BARFOT study on early RA in Sweden. Disease Activity Score 28 joints (DAS28), Health Assessment Questionnaire (HAQ), treatment and European League Against Rheumatism (EULAR) response criteria were registered. In 2010, 1,430 patients completed a questionnaire enquiring about demographics and lifestyle factors.Results:One hundred and thirty-nine of the 1,430 patients (9.7%) were immigrants. At baseline immigrants had higher mean HAQ (1.2 vs 0.97 for non-immigrants, p=0.001), DAS28 (5.6 vs 5.2, p=0.000), visual analog scale (VAS) pain (56 mm vs 45 mm, p=0.000), VAS global health (53 mm vs 44 mm, p=0.000) and tender joint count (TJC) (10 vs 8, p=0.000). These differences persisted for up to 2 years of follow-up (for HAQ, for up to 8 years of follow-up). Immigrant status did not have any effect on swollen joint count (SJC), ESR, CRP or EULAR response. Socioeconomic class did not have any effect on treatment or outcome.Conclusions:Immigrants scored worse in pain, function and TJC for up to 2 years of follow-up, but they did not differ from non-immigrants in objective measures of inflammation or EULAR outcome. This could be due to different perceptions of health and pain and/or the stress of immigration. Socioeconomic class had no effect on treatment or outcome, and this could be due to the relatively egalitarian society in Sweden.

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Evaluation of Serum Calprotectin Level and Disease Activity in Patients with Rheumatoid Arthritis

Current Rheumatology Reviews ◽

10.2174/1573397115666190122113221 ◽

2019 ◽

Vol 15 (4) ◽

pp. 316-320

Author(s):

Mir Amir Aghdashi ◽

Seyedmostafa Seyedmardani ◽

Sholeh Ghasemi ◽

Zohre Khodamoradi

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Inflammatory Arthritis ◽

Unknown Etiology ◽

Tender Joint Count ◽

Serum Samples ◽

Tender Joint ◽

Cross Sectional ◽

Calprotectin Level ◽

Remission Phase

Background: Rheumatoid Arthritis (RA) is the most common type of chronic inflammatory arthritis with unknown etiology marked by a symmetric, peripheral polyarthritis. Calprotectin also can be used as a biomarker of disease activity in inflammatory arthritis and other autoimmune diseases. Objective: In this study, we evaluated the association between serum calprotectin level and severity of RA activity. Methods: A cross-sectional study was conducted on 44 RA patients with disease flare-up. Serum samples were obtained from all patients to measure calprotectin, ESR, CRP prior to starting the treatment and after treatment period in the remission phase. Based on Disease Activity Score 28 (DAS28), disease activity was calculated. Results: Of 44 RA patients, 9(20.5%) were male and 35(79.5%) were female. The mean age of our cases was 53±1.6 years. Seventeen (38.6%) patients had moderate DAS28 and 27(61.4%) had high DAS28. The average level of calprotectin in the flare-up phase was 347.12±203.60 ng/ml and 188.04±23.58 ng/ml in the remission phase. We did not find any significant association between calprotectin and tender joint count (TJC; P=0.22), swollen joint count (SJC; P=0.87), and general health (GH; P=0.59), whereas significant associations were found between the calprotectin level and ESR (p=0.001) and DAS28 (p=0.02). The average calprotectin level in moderate DAS28 (275.21±217.96 ng/ml) was significantly lower than that in high DAS28 (392.4±183.88 ng/ml) (p=0.05). Conclusion: We showed that the serum level of calprotectin can be a useful and reliable biomarker in RA activity and its severity. It also can predict treatment response.

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Systematic Review and Metaanalysis of Patient Self-Report versus Trained Assessor Joint Counts in Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.090569 ◽

2009 ◽

Vol 36 (12) ◽

pp. 2635-2641 ◽

Cited By ~ 38

Author(s):

JENNIFER L. BARTON ◽

LINDSEY A. CRISWELL ◽

RACHEL KAISER ◽

YEA-HUNG CHEN ◽

DEAN SCHILLINGER

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Self Report ◽

Future Research ◽

Tender Joint Count ◽

Tender Joint ◽

Trained Assessor ◽

Tender Joint Counts

Objective.Patient self-report outcomes and physician-performed joint counts are important measures of disease activity and treatment response. This metaanalysis examines the degree of concordance in joint counts between trained assessors and patients with rheumatoid arthritis (RA).Methods.Studies eligible for inclusion met the following criteria: English language; compared patient with trained assessor joint counts; peer-reviewed; and RA diagnosis determined by board-certified or board-eligible specialist or met 1987 American College of Rheumatology criteria. We searched PubMed and Embase to identify articles between 1966 and January 1, 2008. We compared measures of correlation between patients and assessors for either tender/painful or swollen joint counts. We used metaanalysis methods to calculate summary correlation estimates.Results.We retrieved 462 articles and 18 were included. Self-report joint counts were obtained by a text and/or mannequin (picture) format. The summary estimates for the Pearson correlation coefficients for tender joint counts were 0.61 (0.47 lower, 0.75 upper) and for swollen joint counts 0.44 (0.15, 0.73). Summary results for the Spearman correlation coefficients were 0.60 (0.30, 0.90) for tender joint counts and 0.54 (0.35, 0.73) for swollen joint counts.Conclusion.A self-report tender joint count has moderate to marked correlation with those performed by a trained assessor. In contrast, swollen joint counts demonstrate lower levels of correlation. Future research should explore whether integrating self-report tender joint counts into routine care can improve efficiency and quality of care, while directly involving patients in assessment of RA disease activity.

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Early Prognostic Factors for Remission Achievement at Etanercept Therapy in Patients with Juvenile Idiopatic Arthritis Without Systematic Manifestations: Prospective Cohort Study

Вопросы современной педиатрии ◽

10.15690/vsp.v18i1.1989 ◽

2019 ◽

Vol 18 (1) ◽

pp. 31-40

Author(s):

Ekaterina I. Alexeeva ◽

Tatyana M. Dvoryakovskaya ◽

Kseniya B. Isaeva ◽

Tatyana V. Sleptsova ◽

Rina V. Denisova ◽

...

Keyword(s):

Cohort Study ◽

Disease Activity ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Tender Joint Count ◽

Etanercept Therapy ◽

Tender Joint ◽

Demographic Indicators ◽

Early Predictors ◽

Duration Of Illness

Background. Prognosis of therapy results of patients with the juvenile idiopatic arthritis (JIA) without systematic manifestations is the precondition of their treatment efficiency enhancement.Objective. Our aim was to establish early predictors for remission achievement in patients with JIA without systematic manifestations who received Etanercept therapy.Methods. In prospective cohort study the therapy results of patients with JIA without systematic manifestations hospitalized from December, 2009 to August, 2014 and administrated with Etanercept are analysed. The association of initial demographic indicators as well as initial and registered after a month of treatment clinical and laboratory indicators with remission achievement after a year of treatment according to the Wallace criteria is estimated.Results. The research included 197 patients with JIA without systematic manifestations who received Etanercept in 0.4 mg/kg dose twice a week subcutaneously (the maximum single dose — 25 mg). In addition to Etanercept 136 (69%) patients received Methotrexat, 121 (61%) — non-steroidal anti-inflammatory drugs, 10 (5%) — glucocorticosteroids, 6 (3%) — Sulfasalazine. After a year of treatment remission was recorded in 77 out of 197 (39.1%) patients. According to multivariate analysis the remission predictors are the following: tender joint count 4 (odds ratio (OR) 4.38; 95% confidential interval (CI) 2.33–8.55), duration of illness before Etanercept therapy 2 years (OR 1.28; 95% CI 1.02–2.15), disease activity decline according to JADAS71 index 10 points in a month of the therapy including Etanercept (OR 2.59; 95% CI 1.38–5.03). Model sensitivity was 32% (all three criteria in 25/77 patients with remission), specificity — 94% (lack of even one criteria in 113/120 patients who did not achieve remission).Conclusion. The predictors of remission in patients with JIA without systematic manifestations in 1 year of Etanercept therapy are smaller tender joint count prior to therapy, smaller duration of illness as well as significant disease activity decline in a month of the therapy.

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Rheumatoid arthritis activity scores in patients with and without fibromyalgia syndrome

Annals of Saudi Medicine ◽

10.5144/0256-4947.2021.246 ◽

2021 ◽

Vol 41 (4) ◽

pp. 246-252

Author(s):

Yunus Durmaz ◽

Ilker Ilhanli

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Fibromyalgia Syndrome ◽

Conflicts Of Interest ◽

Systemic Disease ◽

Response To Treatment ◽

Unknown Etiology ◽

Tender Joint Count ◽

Tender Joint ◽

Cross Sectional

BACKGROUND: Fibromyalgia syndrome (FM) is a systemic disease of unknown etiology, which can cause widespread musculoskeletal pain. In patients with rheumatoid arthritis (RA), FM can cause an additional symptom burden, which can affect some variables on the RA disease activity score 28 (DAS28), a tool that evaluates 28 joints in RA patients. OBJECTIVE: Compare the results of four different versions of the DAS28 and the parameters used to determine disease activity scores in RA patients with and without FM, and determine whether there are treatment differences between RA patients with and without FM. DESIGN: Retrospective, cross-sectional. SETTING: Tertiary hospital. PATIENTS AND METHODS: We identified patients diagnosed with RA between 1 September 2016 and 1 February 2020 and identified patients with and without FM. MAIN OUTCOME MEASURES: Differences between variables in the DAS28 calculations (tender joint count [TJC], patient global assessment [PGA], and others), between patients with and without FM, and differences between patients with and without FM who were using or not using biological agents. SAMPLE SIZE: 381, including 322 females (84.5%). RESULTS: The frequency of FM in RA patients was 25.7% (89 females, 24.6%). In RA patients with FM, the TJC and PGA median values were significantly higher than in patients without FM ( P <.05). The use of corticosteroids and biological therapy in patients with FM was more frequent than in patients without FM ( P <.05). Compared to patients without FM, patients with FM switched treatment more often because of non-response to treatment ( P =.01) Median values of the DAS28 scores (calculated by four different versions of the instrument) in RA patients with FM were higher than in patients without FM ( P <.05). CONCLUSION: The presence of FM in RA patients may affect the subjective variables in different versions of DAS28 scores, causing the disease activity to score higher on the instrument, erroneously indicating worse disease than is actually present. LIMITATIONS: A single center, retrospective study. CONFLICTS OF INTEREST: None.

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MRI in early rheumatoid arthritis: synovitis and bone marrow oedema are independent predictors of subsequent radiographic progression

Annals of the Rheumatic Diseases ◽

10.1136/ard.2009.123950 ◽

2010 ◽

Vol 70 (3) ◽

pp. 428-433 ◽

Cited By ~ 88

Author(s):

Pernille Bøyesen ◽

Espen A Haavardsholm ◽

Mikkel Østergaard ◽

Désirée van der Heijde ◽

Sølve Sesseng ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Bone Marrow ◽

Early Rheumatoid Arthritis ◽

Radiographic Progression ◽

Bone Marrow Oedema ◽

Tender Joint Count ◽

X Rays ◽

Tender Joint ◽

Reactive Protein

ObjectivesTo determine whether MRI and conventional (clinical and laboratory) measures of inflammation can predict 3-year radiographic changes measured by the van der Heijde Sharp score in patients with early rheumatoid arthritis (RA).Methods55 patients with RA with disease duration <1 year participated in this 3-year follow-up study. Patients were evaluated at baseline, 3, 6, 12 and 36 months by swollen and tender joint count, disease activity score based on 28-joint count, erythrocyte sedimentation rate (ESR), C reactive protein, MRI measures of synovitis, bone marrow oedema and tenosynovitis of the dominant wrist, as well as conventional x-rays of the hands and wrists.ResultsAll measures of inflammation decreased during the follow-up period. ESR, MRI synovitis and MRI bone marrow oedema were independent predictors of 3-year radiographic progression adjusted for age, sex and anti-citrullinated protein antibodies. The 1-year cumulative measures of MRI synovitis and bone marrow oedema provided an improved explanation of variation (adjusted R2) in radiographic change compared with the baseline MRI values (adjusted R2=0.32 and 0.20 vs 0.11 and 0.04, respectively).ConclusionsBoth baseline and 1-year cumulative measures of MRI synovitis and bone marrow oedema independently predicted 3-year radiographic progression. These results confirm that MRI synovitis and MRI bone marrow oedema precede radiographic progression in patients with early RA.

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FRI0277 EFFECTIVENESS OF BDMARDS IN AS AND NR-AXSPA PATIENT POPULATIONS: EXPERIENCE FROM THE CORRONA REGISTRY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3318 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 725.1-726

Author(s):

T. Hunter ◽

T. Blachley ◽

W. Malatestinic ◽

L. Harrold ◽

B. Dube ◽

...

Keyword(s):

Disease Activity ◽

Patient Characteristics ◽

Response Rates ◽

Tender Joint Count ◽

Research Support ◽

Tender Joint ◽

Clinical Registry ◽

Modest Improvement ◽

Asas Criteria ◽

Patient Reported

Background:Axial spondyloarthritis (axSpA) consists of ankylosing spondylitis (AS), also referred to as radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA). AxSpA can lead to reduced mobility, pain, fatigue, and impact quality of life. While bDMARDs are available for treatment, the literature lacks studies exploring their real-world effectiveness in clinical registry patients with axSpA.Table 1.Demographic characteristics and clinical response rates of AxSpA patientsTable 2.TNFi drug survival rate results of early and late disease courseObjectives:To describe patient characteristics of bDMARD initiators among the AS and nr-axSpA populations and the effectiveness of bDMARDs at the 6-month (± 3) post-initiation follow-up (FU) visit in the Corrona PsA/SpA Registry.Methods:This study included patients aged ≥ 18 years with AS per modified NY criteria and nr-axSpA per ASAS criteria enrolled between 3/2013 and 9/2019. Concurrently diagnosed patients with PsA were excluded. Baseline characteristics, such as demographic, clinical, disease activity, treatment, and patient-reported outcomes (PRO), were collected for those initiating a bDMARD at enrollment or during FU; response rates and mean change in disease activity and PRO between initiation and 6-month FU were calculated.Results:The AS (n=179) and nr-axSpA (n=32) bDMARD initiators groups were similar at initiation for mean age (AS: 49.1 yrs, nr-axSpA: 48.9 yrs), ASDAS scores (AS: 2.9, nr-axSpA: 2.8) and patient global assessment (AS: 59.6, nr-axSpA: 60.0). The two groups were different for time from disease duration (AS 8.5 yrs, nr-axSpA, 6.6 yrs), current NSAID use (AS: 64.2%, nr-axSpA: 46.9%) and naivete to cDMARDS (AS: 70.4%, nr-axSpA: 40.6%), TNFs (AS: 47.5%, nr-axSpA: 21.9%), non-TNFs (AS: 96.1%, nr-axSpA: 93.8%) and bDMARDs (AS: 46.9%, nr-axSpA: 21.9%). Patients were similarly impacted by their condition for BASDAI (AS: 5.0, nr-axSpA, 5.6), pain (AS: 55.8, nr-axSpA, 60.8) and fatigue (AS: 51.6, nr-axSpA, 59.9), but there was an imbalance in tender joint count (AS: 2.6, nr-axSpA, 13.4).At 6-month FU, both populations experienced minimal or no change in ASDAS scores (AS: -0.3, nr-axSpA: 0.0) remaining in a high state of disease activity (ASDAS, ≥2.2). A small percent of both groups achieved ASAS20 (AS: 20.1%; nr-axSpA: 21.9%) and ASAS40 (AS: 14 %, nr-axSpA: 15.6%). Further, bDMARD initiators had minimal decreases in BASDAI (AS: -0.6, nr-axSpA: -0.8), pain (AS: -8.5, nr-axSpA: -12.2), and fatigue (AS: -5.0, nr-axSpA: -7.9) scores.Conclusion:AS and nr-axSpA bDMARD initiators had a modest improvement in outcomes at six months. Twenty percent or fewer patients achieved ASAS20 or ASAS40, with many having residual impairment based on ASDAS, BASDAI, pain, and fatigue outcomes at six months. While patients are initiating biologic agents, room for improvement exists as many are not achieving optimal treatment response of inactive (ASDAS, <1.3) or low disease activity (ASDAS, <2.1).Disclosure of Interests:Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Taylor Blachley Employee of: Corrona, LLC, William Malatestinic Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Leslie Harrold Shareholder of: Corrona, LLC – shareholder, Grant/research support from: Pfizer – grant/research support, Consultant of: AbbVie, BMS, Roche – consultant, Employee of: Corrona, LLC – employment, Blessing Dube Employee of: Corrona, LLC, Meghan Glynn Shareholder of: Corrona, LLC – shareholder, Grant/research support from: Pfizer – grant/research support, Employee of: Corrona, LLC – employment, Jeffrey Lisse Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau

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