Background/Purpose: Rheumatoid arthritis (RA) patients from Latin-America present distinctive characteristics when compared to Caucasians, that are known to impact patient´s outcomes. Despite early and more aggressive treatment guidelines recently adopted, some patients require reconstructive joint surgery, considered an indicator of poor prognosis. The objectives of the study were to describe incidence rate of orthopedic and hand surgery indication (OHSI) in a cohort of Mexican Mestizo early RA patients treated with conventional DMARDs according to a T2T strategy and to investigate OHSI predictors.

Methods: Patients enrolled in the cohort had a disease duration of <1 year and complete rheumatic assessments at fixed intervals. Up to February 2018, the cohort comprised 185 RA patients recruited from 2004 onwards, with at least fourteen months of follow-up; 2.7% were dead, 23.3% lost to follow-up and 74% had active follow-up. Charts were reviewed and incidence rate of OHSI was calculated. A nested within a cohort case-control study was designed to investigate predictors; cases (patients with OHSI) were paired to controls (1:4) according to age (± 5 years), sex, baseline RF and ACCP; cumulative disease activity (summarized as DAS28, first sustained remission [SR], time in SR, number of flares and % of follow-up in remission status), cumulative treatment (N° DMARD/patient, patients with corticosteroids and % of time with corticosteroids), and cumulative persistence (N° of patients persistent and % of follow-up patients were persistent) were compared between cases and controls. Logistic regression´s models included baseline and cumulative (up to OHSI or equivalent) variables. Local IRB approved the study.

Results: Patients entering the cohort were predominantly middle-aged (mean±SD age of 38.5±12.9 years) female (87.6%), with (mean±SD) 5.4±2.6 months of disease duration. Up to cut-off, the cohort contributed to 1538 patient-years of follow-up. There were 12 patients with incidental OHSI, at a (mean±SD) follow-up of 85±44.5 months; 9 (75%) received orthopedic surgery indication meanwhile 3 (25%) received hand surgery indication; incident global rate was of 0.8/100 patient-years. Regression models included baseline variables (months of symptom´s disease duration) and cumulative variables (N° of flares/patient, % of follow-up in remission status, N° of patients persistent and % of follow-up patients were persistent with therapy). Longer symptom´s duration at referral to the cohort (OR: 1.313, 95%CI: 1.02-1.68, p=0.032) and higher number of flares (OR: 1.608, 95%CI: 1.05-1.61, p=0.015) were predictors of OHSI. ROC showed that the best cut-off for symptom´s duration and cumulative number of flares to predict OHSI were 6 months (Sensitivity: 0.833; Specificity: 0.665; AUC: 0.746, 95% CI: 0.593-0.899) and 5 flares/patient (Sensitivity: 0.750; Specificity: 0.625; AUC: 0.702, 95% CI: 0.522-0.882), respectively.

Conclusion:

Early referral for appropriated management according to a T2T strategy and flares controls may prevent OHSI in Hispanic early RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/early-referral-and-flares-control-prevent-orthopaedic-and-hand-surgery-indication-in-a-dynamic-cohort-of-hispanic-early-rheumatoid-arthritis-patients/