Background/Purpose: It is common for RA patients to interrupt their DMARD use due to events like infection, surgery, or pregnancy. Many RA patients may need to manage their symptoms during these times. Little is known about the characteristics of patients who have a break in their DMARD regimen and whether the use of a bridging medication produces better clinical and patient reported outcomes.

Methods: Clinical and patient reported data were collected from a prospective RA cohort. Data included whether patients reported DMARD interruption for any duration of time in the past 6 months and if they used a bridging medication (corticosteroid and/or NSAID) during the DMARD break.  All data were collected at the time of survey. The outcomes (VAS Pain, fatigue, and patient global) were also collected at a study visit approximately 6 months prior and DAS28-CRP3 collected approximately 1 year prior.  In univariate analyses, clinical and demographic characteristics of patients who had a DMARD interruption and used of a bridging medication were compared to patients who did not use of a bridging medication. The outcomes were evaluated in stepwise multiple linear regression models, adjusting for potential covariates of univariate significance (p<0.15) to assess the impact of a bridging medication (Figure).

Results: The study surveyed 503 RA patients, of which 112 (22%) reported a DMARD interruption in the last 6 months. Patients who reported a DMARD interruption had a median age of 59 (IQR 49.5, 68), were 85% female, and had median disease duration of 15 years (IQR 9, 25). Patients who used a bridging medication during a DMARD interruption (n=39) had higher disease activity (p=0.0002), fatigue (p=0.03), and pain (p<0.001) at the time of the survey compared to patients who did not use a bridging medication. In the final stepwise regression models evaluating the outcomes, comparing patients who did versus did not use a bridging medication, pain, fatigue, and patient global  were no better with a bridging medication even after adjustment for baseline outcome severity (Figure). Use of a bridging medication was associated with a worse DAS28-CRP3 (p=0.008) after adjusting for covariates and baseline DAS28-CRP3 level (Figure).

Conclusion: In this study, nearly one quarter of RA patients reported an interruption of their DMARD regimen in the past 6 months and one third used an NSAID and/or corticosteroid to manage their symptoms during the break. Use of a bridging medication was not associated with better patient reported outcomes and patients had worse disease activity after the break. Better treatments for patients who need to manage symptoms during a DMARD interruption may be warranted.