ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2416

Do Patterns of Joint Swelling or Tenderness in Rheumatoid Arthritis Patients Impact Disease Activity Outcomes and Pain?  Implications for Clinical Practice

Regan Arendse1, John Kelsall2, J. Antonio Avina-Zubieta3, Philip Baer4, Erica Weinberg4, Jude Rodrigues5, Algis Jovaisas6, Isabelle Fortin7, Maqbool Sheriff8, Majed M. Khraishi9, Emmanouil Rampakakis10, John S. Sampalis10, Francois Nantel11, Susan Otawa12 and Allen J Lehman12, 1University of Saskatchewan, Saskatoon, SK, Canada, 2The Mary Pack Arthritis Centre, Vancouver, BC, Canada, 3Rheumatology, Arthritis Research Centre of Canada, Richmond, BC, Canada, 4Private Practice, Scarborough, ON, Canada, 5Clinical Research and Arthritis Centre, Windsor, ON, Canada, 6194 Main Street, University of Ottawa, Ottawa, ON, Canada, 7Centre de Rhumatologie de l'Est du Québec, Rimouski, QC, Canada, 8Nanaimo Regional General Hospital, Nanaimo, BC, Canada, 9Nexus Clinical Research, Memorial University of Newfoundland, St Johns, NF, Canada, 10JSS Medical Research, Montreal, QC, Canada, 11Janssen Inc., Toronto, ON, Canada, 12Medical Affairs, Janssen Inc., Toronto, ON, Canada

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: , , ,

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Impact of Various Interventions and Therapeutic Approaches

Session Type: Abstract Submissions (ACR)

Background/Purpose

This analysis aimed to describe the pattern of specific joint involvement (tender and/or swollen) pre- and post-TNFi treatment and the impact of specific joint pattern involvement on composite score outcomes and pain.

Methods

BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with infliximab (IFX) or golimumab (GLM). In this analysis, RA patients included those treated with IFX between 2002-2014 or with GLM between 2010-2014. Based on joint involvement 7 groups were created: shoulder(s), elbow(s), metacarpophalangeal (MCP(s)), wrist(s), proximal interphalangeal (PIP(s)), knee(s), and thumb(s). The impact of specific joints on disease activity indices and pain was assessed with the independent-samples t-test; linear regression produced adjusted estimates.

Results

A total of 1030 RA patients were included with 5177 assessments. At baseline, MCP(s) (84.8%) and wrist(s) (66.1%) were the most commonly swollen joints. Tenderness was most frequent at baseline in these two joint types (81.1% and 70.9% of patients, respectively). Swelling/tenderness rates in all joint groups were significantly lower (Table 1) among patients enrolled in 2010-2013 vs. those enrolled in 2002-2005; no significant differences, however, were observed in joint involvement pattern.

Swelling and tenderness in all joint groups were associated with significantly (P<0.001) higher pain. Upon adjusting for age, gender and the total number of swollen (SJC28) or tender (TJC28) joints, swollen shoulder(s) and knee(s), and tender shoulder(s) and elbow(s) had the biggest impact on pain. Swollen MCP(s), knee(s) and thumb(s) had the greatest impact on DAS28, while for CDAI and SDAI swollen thumb(s) and swollen thumb(s) and knee(s), respectively, showed the highest association. Tender wrist(s), shoulder(s), and knee(s) showed the highest association with DAS28, while tender MCP(s) had the greatest impact on CDAI and SDAI. However, all indices were significantly higher among cases with swollen thumb(s) (unstandardized coefficient (B): BDAS28=0.25, P=0.006; BCDAI=2.09, P=0.001; BSDAI=2.66, P=0.001).

Conclusion
Although joint swelling/tenderness documented at anti-TNF initiation has decreased over time, the profile of affected joints has remained stable. Swelling/tenderness in specific joint groups was differentially associated with pain, with larger joints having the greatest impact. Furthermore, differences were observed in levels of disease activity based on the type of affected joint which could be attributed to their impact on patient global assessment. These results suggest that location of joint involvement, in addition to the number of affected joints, has an independent impact on pain.

Table 1: Pattern of Swelling or Tenderness by Enrolment Period

Swelling / Tenderness by Joint Type

Enrolment Period

2002-2005

(N=412)

2010-2014

(N=278)

P-value

Swollen Joint Count, mean (SD)

13.1 (7.1)

7.4 (6.1)

P<0.001

Swollen Shoulder(s)

22.1%

12.2%

<0.001

Swollen Elbow(s)

35.7%

18.0%

<0.001

Swollen MCP(s)

90.5%

78.8%

<0.001

Swollen Wrist(s)

76.7%

51.1%

<0.001

Swollen PIP(s)

75.0%

48.9%

<0.001

Swollen Knee(s)

48.5%

25.9%

<0.001

Swollen Thumb(s)

42.0%

12.6%

<0.001

Tender joint Count, mean (SD)

15.2 (8.0)

8.4 (7.3)

<0.001

Tender Shoulder(s)

65.0%

40.6%

<0.001

Tender Elbow(s)

49.0%

24.1%

<0.001

Tender MCP(s)

87.6%

69.1%

<0.001

Tender Wrist(s)

80.8%

55.4%

<0.001

Tender PIP(s)

76.7%

48.6%

<0.001

Tender Knee(s)

61.2%

38.5%

<0.001

Tender Thumb(s)

46.8%

17.6%

<0.001

 

Disclosure:

R. Arendse,

Janssen Inc.,

5;

J. Kelsall,

Janssen Inc.,

5;

J. A. Avina-Zubieta,
None;

P. Baer,

Janssen Inc.,

5;

E. Weinberg,
None;

J. Rodrigues,

Janssen Inc.,

5;

A. Jovaisas,

Janssen Inc.,

5;

I. Fortin,

Janssen Inc.,

5;

M. Sheriff,

Janssen Inc.,

5;

M. M. Khraishi,

Janssen Inc.,

5;

E. Rampakakis,
None;

J. S. Sampalis,
None;

F. Nantel,

Janssen Inc.,

3;

S. Otawa,

Janssen Inc.,

3;

A. J. Lehman,

Janssen Inc.,

3.

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