ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 191

Does Specific Joint Involvement In Rheumatoid Arthritis Patients Predict Patient Reported Outcomes?  Implications For Clinical Practice

Regan Arendse1, William G. Bensen2, Andrew Chow3, Jude F. Rodrigues4, Sanjay Dixit5, Dalton E. Sholter6, Philip Baer7, Milton F. Baker8, Denis Choquette9, Isabelle Fortin10, Algis Jovaisas11, Emmanouil Rampakakis12, John S. Sampalis12, Francois Nantel13, Susan M. Otawa14, May Shawi15 and Allen J. Lehman14, 1University of Saskatchewan, Saskatoon, SK, Canada, 2Department of Medicine, Division of Rheumatology, Clinical Professor, McMaster University, Hamilton, ON, Canada, 3University of Toronto, McMaster University, Credit Valley Rheumatology, Mississauga, ON, Canada, 4Rheumatology, Windsor, ON, Canada, 5McMaster University, Hamilton, ON, Canada, 6Rheumatology Associates, Edmonton, AB, Canada, 7Private Practice, Scarborough, ON, Canada, 8University of Victoria, Victoria, BC, Canada, 9Rheumatology, Institut de rhumatologie de Montréal (IRM), Montréal, QC, Canada, 10Centre de rhumatologie de l'est du Québec (CREQ), Rimouski, QC, Canada, 11Division of Rheumatology, University of Ottawa, Ottawa, ON, Canada, 12JSS Medical Research, Montreal, QC, Canada, 13Janssen Inc., Toronto, ON, Canada, 14Medical Affairs, Janssen Inc., Toronto, ON, Canada, 15Medical Affairs, Janssen Canada Inc, Toronto, ON, Canada

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Title: Health Services Research, Quality Measures and Quality of Care-Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Assessment of functional (dis)ability in rheumatoid arthritis (RA) is subject to patient judgment when appraising their ability to do daily activities. The aim of this analysis was to describe the impact of specific joint involvement on patient reported outcomes (PROs) – functional activity, pain and patient global assessment of disease activity (PtGA) – and to identify joints most resistant to treatment over time.

Methods:

Biologic Treatment Registry Across Canada (BioTRAC) is an ongoing, prospective, registry of patients initiating treatment for RA, AS, or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for less than six months. In this analysis, RA patients treated with infliximab between 2002 and 2012 or with golimumab between 2010 and 2012 were included. Based on joint involvement seven groups were created: shoulder(s), elbow(s), metacarpophalangeal (MCP), wrist(s), proximal interphalangeal (PIP), knee(s), and thumb(s). The impact of specific joints on patient outcomes was assessed with the independent-samples t-test. Linear regression was used in order to produce adjusted estimates. 

Results:

A total of 935 RA patients with 4854 assessments were included. Swelling, tenderness, and swelling and/or tenderness in all joint groups were associated with significantly (P<0.001) higher HAQ-DI, PtGA, and pain. Upon adjusting for age, gender and the total number of swollen (SJC28) and tender (TJC28) joints, swelling in all joint groups but the thumb(s) had a significant impact on PtGA, pain and HAQ. Similarly, tenderness in all joints but PIP had a significant impact on these parameters. Overall, swelling and/or tenderness at specific joints, shoulders, wrists and knees, had the greatest impact on HAQ-DI, PtGA, and pain (P<0.001). Swollen and/or tender PIP(s) did not have a significant effect on any PRO.  At baseline, the MCP joint(s) and the wrist(s) were the most commonly swollen (86.4% and 67.9% of patients, respectively) or tender (82.9% and 73.1%, respectively) joints. Upon 12 months of treatment, the MCP joints were the joints most resistant to treatment, still remaining affected.    

Table 1: Impact of Specific Joint Involvement on PROs

 

Joint Group

HAQ-DI

PtGA

Pain

Swelling

Shoulder(s)

0.055*

0.049*

0.061*

Elbow(s)

0.090*

0.059*

0.053*

MCP

0.085*

0.103*

0.100*

Wrist(s)

0.106*

0.113*

0.108*

PIP

0.048*

0.032

0.044*

Knee(s)

0.085*

0.098*

0.102*

Thumb(s)

0.032

0.015

0.014

Tenderness

Shoulder(s)

0.114*

0.075*

0.090*

Elbow(s)

0.075*

0.060*

0.065*

MCP

0.042*

0.042*

0.049*

Wrist(s)

0.100*

0.112*

0.109*

PIP

0.014

0.002

0.007

Knee(s)

0.102*

0.103*

0.106*

Thumb(s)

-0.045*

-0.029

-0.034*

Swelling and/or Tenderness

Shoulder(s)

0.130*

0.082*

0.103*

Elbow(s)

0.096*

0.069*

0.072*

MCP

0.015

0.041*

0.043*

Wrist(s)

0.105*

0.088*

0.086*

PIP

0.008

-0.016

-0.015

Knee(s)

0.095*

0.097*

0.101*

Thumb(s)

-0.031

-0.034*

-0.040*

*P<0.05. Standardized coefficients upon adjusting for age, gender, and number of affected joints

Conclusion:

Significant variability in PROs exists based on the presence of swelling and/or tenderness in specific joint groups. Swelling/tenderness of shoulders, wrists and knees were the main drivers of HAQ-DI, PtGA and pain. The results have important implications for the achievement of disease remission and would suggest that the joint type in addition to the number of affected joints has unique impact on PROs.

Disclosure:

R. Arendse,
None;

W. G. Bensen,
None;

A. Chow,
None;

J. F. Rodrigues,
None;

S. Dixit,
None;

D. E. Sholter,
None;

P. Baer,

Janssen Pharmaceutica Product, L.P.,

5;

M. F. Baker,
None;

D. Choquette,
None;

I. Fortin,
None;

A. Jovaisas,

Janssen Pharmaceutica Product, L.P ,

5;

E. Rampakakis,
None;

J. S. Sampalis,
None;

F. Nantel,
None;

S. M. Otawa,

Janssen Canada,

3;

M. Shawi,

Janssen Canada,

3;

A. J. Lehman,

Janssen Canada,

3.

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