Background/Purpose: Although disability is part of the ‘core set’ of outcomes for RA research recommended by OMERACT (1), current therapeutic strategies focus on inflammation. The treat to target approach instigated in 2010 (2) saw a step-change in RA management, with frequent clinical review to achieve remission or low disease activity. The aim of this study was to compare disease activity (DAS28) and disability (measured by HAQ) in 2 early RA cohorts, both before and after the implementation of treat to target approaches.

Methods: Cases with recent onset RA recruited to Yorkshire Early Arthritis Register (YEAR) between 2002 and 2009 were treated with a ‘step-up’ approach, using synthetic DMARDs. Of 725 cases included, 585 met 1987 ACR RA classification criteria and a further 115 met 2010 criteria. A second cohort, IACON (INflammatory Arthritis CONtinuum), recruited patients with early inflammatory arthritis between 2010 and 2014, treated according to ‘treat to target’ principles including biologic therapies. Data from 384 patients meeting 2010 ACR/EULAR classification were applied to the present study. Latent growth curve models of change in DAS28 and HAQ were compared between YEAR and IACON. Latent class growth analysis identified latent trajectories of change in HAQ-DI and logistic regression tested baseline predictors of HAQ trajectory, including age, gender, BMI, smoking status, CCP (RF considered separately) and fatigue. Presence of one or more common comorbidities was considered for the IACON group.

Results: Mean baseline DAS28 and HAQ were lower in IACON than YEAR (DAS28 4.01 vs. 4.70 and HAQ 1.13 vs. 1.27 in IACON and YEAR, respectively). A greater proportion of overall fall in DAS28 was achieved after 6 months in IACON (84%) than YEAR (68%). There were three latent trajectories of change in HAQ in YEAR and two in IACON (Figure 1). The ‘high stable’ group was not seen in IACON, possibly reflecting the more favourable change in DAS28 observed in this group. However, 66% of IACON cases followed a ‘moderate reducing’ HAQ trajectory, similar to the corresponding trajectory in YEAR. In both cohorts, female gender and higher baseline fatigue visual analogue score (VAS) predicted adverse HAQ trajectory. Odds ratios (OR) for moderate reducing compared to low reducing groups for females were 2.58 (95% confidence interval 1.69, 4.49) in YEAR and 5.81 (2.44, 14.29) in IACON. Corresponding OR per cm fatigue were 1.13 (1.07, 1.20) in YEAR and 1.16 (1.12-1.20) in IACON.

Conclusion: More favourable trajectories of change in DAS28 and HAQ were seen in the Treat to Target group, but females and those with greater fatigue were more likely to fit into an adverse HAQ trajectory, suggesting that such patients may benefit from interventions to improve function as well as reduce inflammation. References

1. Boers, M., et al. 1994. J Rheumatol Suppl, 41, 86.
2. Smolen JS, et al. Ann Rheum Dis 2010;69(4):631.

   

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/greater-fatigue-at-baseline-and-female-gender-predict-worse-disability-in-early-ra-despite-treatment-to-target-a-comparison-of-two-observational-cohort-studies-from-the-united-kingdom/