Background/Purpose: Treating rheumatoid arthritis (RA) patients to target (T2T) has been shown to result in better outcomes in patients with relatively recent onset RA. The implementation of this method requires performing disease activity measures (DAMs) with the disease activity score in 28 joints (DAS28) being the most commonly used. The use of clinically based DAMs in patients with longstanding RA is problematic as structural damage, and other comorbidities can lead to elevated scores because of the impact on composite elements not related to inflammation i.e. patient global and tender joint count. Including additional DAMs, such as a power Doppler joint count (UPD) and multibiomarker disease activity (MBDA) could possibly lead to better assessment of this patient population. The purpose of this abstract is to determine the changes in these three diverse DAMs and the relationships of these changes following the initiation of specific treatment modalities in patient with longstanding RA.

Methods: Patients at a community based rheumatology clinic undergo DAM assessments on a routine basis as part of the implementation of a T2T strategy. These assessments include the DAS28CRP, a UPD, and the MBDA. The UPD includes scoring at six dorsal wrist and six dorsal MCP sites. Patients underwent assessments prior to change in therapy, and then generally about six months later. Patients who were on biologics and found to be under inadequate control, had their biologic discontinued and the new therapy added later, depending on the half-life of the discontinued medication. The average duration of RA in patients at this clinic is > 10 years. The average DAS28CRP 4.18 +/- 1.32, average MBDA 41.4 +/- 14, and the average UPD 7.8 +/- 4.3.

Results:

*P value < 0.05

Conclusion: Changes in diverse DAMs have moderate to high correlations following the initiation of specific therapy with most treatment modalities utilized in the management of longstanding RA. Tocilizumab did not have a positive correlation between DAS and the MBDA, which has been previously reported, and is presumed to be secondary to its mode of action which leads to significant elevation of IL-6 in the serum. Tofacitinib, a Jak-1 inhibitor, did not have a significant correlation between DAS and the MBNA, which has also been reported recently for another Jak-1 inhibitor in development, but had significant correlation with UPD and the MBNA in this study. This data suggest the validity of adding more diverse DAMs, such as UPD, and MBDA to clinical measures, such as the DAS28CRP, as endpoints in the implementation of a T2T strategy in the management of longstanding RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/changes-in-diverse-disease-activity-measures-are-highly-correlated-following-the-initiation-of-most-treatment-modalities-in-the-management-of-longstanding-rheumatoid-arthritis/