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Abstract Number: 2465

Discordance Between Tender and Swollen Joint Count and Patient’s and Evaluator’s Global Assessment May Reduce Likelihood of Remission in Rheumatoid Arthritis

Brigitte Michelsen1,2, Karen M Fagerli1, Elisabeth Lie1, Hilde B Hammer3, Eirik K Kristianslund1, Glenn Haugeberg4,5 and Tore K Kvien1, 1Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, 2Dept. of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway, 3Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, 4Dept. of Rheumatology, Martina Hansens Hospital, Bærum, Norway, 5Dept. of Rheumatology, The Norwegian University of Science and Technology, Trondheim, Norway

Meeting: ACR/ARHP Annual Meeting 2016

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Tuesday, November 15, 2016

Title: Rheumatoid Arthritis – Clinical Aspects - Poster III: Treatment – Monitoring, Outcomes, Adverse Events

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Chronification of pain and development of central sensitization and conditioned pain modulation can lead to disconnection between tender and swollen joint count, which may be challenging for disease evaluation and treatment. Studies exploring the relationship between tender and swollen joints discordance as predictor of remission in inflammatory arthritides are lacking in the current literature. In this study we aimed to investigate the predictive value of numeric differences between 28 tender and swollen joint count (deltaTSJ) and patient’s and evaluator’s global assessment (deltaPEG) on remission in rheumatoid arthritis (RA).

Methods: From the prospective, multicenter NOR-DMARD study we included RA patients starting first-time tumor necrosis factor inhibitors (TNFi) and DMARD naïve patients starting methotrexate between 2000 and 2012. The predictive value of deltaTSJ and deltaPEG on remission was explored in prespecified logistic regression models adjusted for age, sex, disease duration and smoking.

Results: A total of 2735 RA patients were included (mean (SD) age 55.0 (13.5) years, disease duration 4.5 (8.2) years, 69.7% females, 31.7% current smokers, baseline median (IQR) 28 tender joints 6 (9), 28 swollen joints 6 (7), deltaTSJ 1 (5), baseline mean (SD) evaluator’s global assessment 40.3 (19.4), patient’s global assessment 49.7 (24.8), deltaPEG 9.4 (25.0), DAS28ESR 5.0 (1.4), baseline median (IQR) SDAI 24.5 (19.6), CDAI 10.4 (13.3).  Bar charts of percentages of patients in remission at 6 months according to categorization of deltaPEG and deltaTSJ into quartiles showed reduced probability of remission with increasing deltaPEG and deltaTSJ (unadjusted values; figures).

Baseline deltaTSJ and deltaPEG were negative predictors of achieving DAS28<2.6, SDAI≤3.3, CDAI≤2.8 and ACR/EULAR Boolean remission after 3 and 6 months (table).            

  Months DAS28ESR < 2.6 SDAI ≤ 3.3 CDA I ≤ 2.8 ACR/EULAR Boolean
deltaTSJ 3 0.97 [0.95, 0.99] p<0.001 0.96 [0.94, 0.98] p<0.001 0.95 [0.93, 0.98] p<0.001 0.96 [0.94, 0.99] p=0.003
6 0.96 [0.95, 0.98] p<0.001 0.96 [0.94, 0.98] p<0.001 0.96 [0.94, 0.98] p<0.001 0.96 [0.94, 0.98] p=0.001
deltaPEG 3 0.96 [0.94, 0.99] p=0.009 0.99 [0.99, 0.998] p=0.01 0.99 [0.99, 0.997] p=0.004 0.99 [0.98, 0.996] p=0.001
6 0.99 [0.99, 0.997] p=0.002 0.99 [0.98, 0.99] p<0.001 0.99 [0.98, 0.99] p<0.001 0.99 [0.98, 0.995] p=0.001

Data are presented as OR [95% CI]  

Conclusion: Discordance between patient’s and physician’s evaluation of disease activity reflected through deltaTSJ and deltaPEG may reduce likelihood of remission in RA. The findings are relevant for use of the treat-to-target strategy.  

Disclosure: B. Michelsen, None; K. M. Fagerli, None; E. Lie, None; H. B. Hammer, None; E. K. Kristianslund, None; G. Haugeberg, None; T. K. Kvien, Biogen, BMS, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Hospira, Merck-Serono, Novartis, Orion Pharma, Prizer, Sandoz, UCB, 5.

To cite this abstract in AMA style:

Michelsen B, Fagerli KM, Lie E, Hammer HB, Kristianslund EK, Haugeberg G, Kvien TK. Discordance Between Tender and Swollen Joint Count and Patient’s and Evaluator’s Global Assessment May Reduce Likelihood of Remission in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/discordance-between-tender-and-swollen-joint-count-and-patients-and-evaluators-global-assessment-may-reduce-likelihood-of-remission-in-rheumatoid-arthritis/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/discordance-between-tender-and-swollen-joint-count-and-patients-and-evaluators-global-assessment-may-reduce-likelihood-of-remission-in-rheumatoid-arthritis/