Background/Purpose: A treat-to target (T2T) strategy is recommended for the management of rheumatoid arthritis (RA), with the target being remission or at least low disease activity. Many do not reach these targets (45% at our centre), some remaining in moderate disease activity with DAS28 between 3.2 and 5.1 (MDAS). We recently reported that baseline disability predicted persistent poor function and health-related quality of life (HRQOL) at 12-months in biologic-naïve patients in persistent MDAS(1). In patients receiving biologic DMARDs (bDMARDs) the outcomes of those in persistent MDAS are less certain. We therefore studied factors that predicted function and HRQOL in patients taking/previously receiving bDMARDs.

Methods: We analysed data from the RA Centre, which has aimed for DAS28 remission in all patients since 2006, in a Health Research Authority-approved study, studying outcomes over 12-months. Persistent MDAS was defined as patients with two consecutive MDAS scores, with the second score taken as “baseline”. Linear regression models tested relationships between baseline variables and a) 12-month Health Assessment Questionnaire-Disability Index (HAQ-DI) scores, b) rank-transformed EQ-5D-3L index scores, and c) 12-month changes in HAQ-DI and EQ-5D-3L index scores. Factors with associations achieving p<0.1 in univariate analysis, were included in multivariate models.

Results: 188 patients currently/previously taking biologics with persistent MDAS were identified (Table). Most were female, seropositive, and had established disease. In multivariate analysis, only HAQ-DI associated with 12-month HAQ-DI scores (P<0.001); the β-value of 0.76 suggested that per unit increase in baseline HAQ-DI, end-point HAQ-DI scores were 0.76 units higher. In multivariate analysis, HAQ-DI (β=-0.21; P<0.001) and tender joint counts (β =-0.03, P=0.006) associated with 12-month changes in HAQ-DI, indicating that higher baseline HAQ-DI scores associated with larger 12-month reductions in HAQ-DI. In multivariate analysis, baseline HAQ-DI (β=-0.35; P=0.003) and EQ-5D (β=1.23, P=0.014) associated with 12-month EQ-5D scores, and baseline EQ-5D scores associated with 12-month changes in EQ-5D scores (β=-0.40, P=0.003).

Conclusion: These data show that many patients with persistent MDAS have ongoing disability despite intensive treatment. Also of note, 96% patients score moderate to severe pain on EQ-5D pain scale. Baseline HAQ-DI was a key predictor of end-point disability and HRQOL, with higher baseline HAQ-DI scores associating with higher and lower 12-month HAQ-DI and EQ-5D scores, respectively. Despite this, in routine practice, the HAQ-DI is rarely measured. These findings highlight the importance of measuring and focussing on patient-reported outcome measures like the HAQ-DI, in managing patients with RA.

(1) Scott I.C. et al, Rheumatology, Volume 57, Issue suppl_3, 1 April 2018

Table: Patient Characteristics

ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-disability-and-health-related-quality-of-life-in-biologic-treated-patients-with-rheumatoid-arthritis-in-persistent-moderate-disease-activity/