Session Information
Date: Sunday, November 5, 2017
Title: Rheumatoid Arthritis – Clinical Aspects Poster I: Treatment Patterns and Response
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Viral hepatitis may complicate the treatment of RA since select DMARD have the potential to cause hepatotoxicity or reactivation of latent viral infections. Whether treatment patterns and RA outcomes are impacted by this comorbid condition is not well studied. Similarly, little is known about RA factors and the risk the developing of hepatitis. Thus, we assessed the associations of viral hepatitis with RA disease outcomes and DMARD use and determined the RA factors predictive of incident hepatitis.
Methods: We studied participants with RA within the National Data Bank for Rheumatic Diseases (NDB) from 2004 to 2017. Sociodemographic, health behaviors, comorbidities, RA measures, and medications were collected every 6 months via self-report. Additionally, participants were assessed for current or prior history of viral hepatitis. We used multivariable linear and logistic regression models to assess associations of prior viral hepatitis with RA outcome measures and treatments. We also assessed the associations of RA measures and DMARD with incident viral hepatitis using multivariable Cox proportional hazard regression models.
Results: Among 22,942 participants with RA, current or prior hepatitis was self-reported present in 207 (Hepatitis A), 165 (Hepatitis B), and 317 (Hepatitis C). Adjusting for age, sex, employment, education level, comorbidity index, smoking, alcohol and drug use, patients with prior hepatitis B and C had higher pain scores while patients with hepatitis C had higher patient activity scale (PAS) scores. Hepatitis C was also marginally associated with higher patient global assessment scores. MTX use was less frequent in those with hepatitis B and C while the use of NSAIDs and biologics did not differ between groups (Table 1). Over 90,952 patient-years of follow-up, 132 patients developed incident viral hepatitis. After multivariable adjustment, higher pain and PAS scores were independently associated with an increased risk of viral hepatitis (Table 2). Biologics were not associated with incident viral hepatitis while MTX was associated with a lower risk of incident hepatitis. To assess whether misclassification of prevalent hepatitis as incident hepatitis was occurring, we used a 6-month lag for viral hepatitis diagnosis, finding similar results.
Conclusion: History of viral hepatitis infection is associated with worse RA patient reported outcomes measures and lower use of MTX. Clinicians should be aware of the potential for viral hepatitis to influence patient reported outcomes measures in RA. Reassuringly, biologic DMARD do not appear to increase the risk of incident viral hepatitis.
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Table 1: Association of viral hepatitis with RA outcomes and treatment |
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Outcome |
Hepatitis A |
Hepatitis B |
Hepatitis C |
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Linear regression |
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HAQ |
0.01 (-0.09, 0.11) |
0.02 (-0.84, 0.13) |
0.05 (-0.03, 0.12) |
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Pain scale |
-0.02 (-0.40, 0.36) |
0.59 (0.18, 1.01)* |
0.48 (0.18, 0.79)* |
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Patient global |
0.01 (-0.31, 0.34) |
0.26 (-0.12, 0.63) |
0.28 (-0.05, 0.56) |
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Patient activity score |
0.01 (-0.28, 0.29) |
0.31 (-0.07, 0.62) |
0.30 (0.06, 0.55)* |
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SF-36 Physical Summary |
-0.17 (-1.60, 1.26) |
-1.23 (-2.96, 0.49) |
-0.58 (-1.88, 0.71) |
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SF-36 Mental Summary |
-1.37 (-3.25, 0.51) |
-0.92 (-3.03, 1.20) |
-0.93 (-2.32, 0.47) |
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Logistic regression |
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Methotrexate |
0.83 (0.63, 1.10) |
0.42 (0.30, 0.59)* |
0.60 (0.47, 0.76)* |
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Leflunomide |
0.83 (0.51, 1.35) |
0.64 (0.34, 1.81) |
0.87 (0.59, 1.29) |
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Biologic |
1.02 (0.77, 1.34) |
0.90 (0.65, 1.23) |
0.95 (0.75, 1.19) |
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Any NSAID |
0.93 (0.70, 1.23) |
0.84 (0.61, 1.16) |
0.99 (0.79, 1.25) |
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Prednisone |
1.11 (0.82, 1.50) |
0.58 (0.40, 0.84)* |
0.93 (0.72, 1.20) |
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Values β or Odds ratio (95%CI) * p <0.05 Parameters assessed in separate models, each adjusted for age, sex, employment, education level, comorbidity index, smoking, alcohol and drug use |
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Table 2: Association of RA measures and treatments with incident viral hepatitis |
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Variable |
Hazard Ratio |
95%CI |
p-value |
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RA disease duration (years) |
1.00 |
0.98, 1.01 |
0.578 |
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HAQ |
1.12 |
0.88, 1.41 |
0.356 |
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Pain scale (0-10) |
1.06 |
1.00, 1.13 |
0.039 |
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Patient global (0-10) |
1.05 |
0.98, 1.12 |
0.115 |
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Patient activity score (0-10) |
1.07 |
1.00, 1.15 |
0.046 |
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SF-36 Physical summary |
0.98 |
0.95, 0.99 |
0.022 |
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SF-36 Mental summary |
0.98 |
0.96, 0.99 |
0.040 |
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Methotrexate |
0.58 |
0.40, 0.83 |
0.003 |
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Leflunomide |
1.05 |
0.61, 1.79 |
0.728 |
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Biologic |
0.93 |
0.66, 1.31 |
0.693 |
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Any NSAID |
1.25 |
0.89, 1.77 |
0.193 |
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Prednisone |
1.34 |
0.93, 1.93 |
0.109 |
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Parameters assessed in separate models, each adjusted for age, sex, employment, education level, comorbidity index, smoking, alcohol and drug use |
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To cite this abstract in AMA style:
Timilsina S, Sayles H, England BR, O'Dell JR, Mikuls TR, Michaud K. Viral Hepatitis Influences Patient Reported Outcomes Measures in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/viral-hepatitis-influences-patient-reported-outcomes-measures-in-rheumatoid-arthritis/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/viral-hepatitis-influences-patient-reported-outcomes-measures-in-rheumatoid-arthritis/