Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Patient reported outcome measures (PROM) are used in routine practice for assessment of disease activity. They have been shown to correlate well with other composite measures. Current guidelines suggest remission or low disease activity (LDA) as the target of therapy in rheumatoid arthritis (RA). Our objective was to assess the predictive validity of early LDA defined by PROMs on future joint damage and disability in patients with early RA
Methods:
We studied patients included in the Study of New Onset Rheumatoid Arthritis (SONORA), a multicenter early RA cohort and Ontario Best Practices Research Initiative (OBRI), a current clinical registry of RA patients followed in routine care. Patients with symptom duration ≤ 12 months at enrollment were included. In SONORA analysis, the main predictors were LDA (RADAI<2.2) at 4mo and 12 mo. Multivariate linear regression analysis was used for assessment of LDA predicting HAQ at 3 years and mutivariate logistic regression models were used for assessment of the impact of LDA on x-ray progression over 2 years adjusting for potential confounders. In OBRI analysis, the predictive validity of LDA at6 months (RADAI<2.2 and RAPID3<2) on HAQ at 2 years was estimated using multiple linear regression analysis. .
Results:
There were 984 early RA patients in SONORA. Baseline (BSL) mean(sd) HAQ was 1.0 (0.7) that improved to 0.7 (0.7) at 3 years. At 2 years, 116(17%) patients developed radiographic progression. At 4 mo 25% achieved LDA and it increased to 37% at 1 year. LDA at both 4mo and 1 year was a significant predictor of lower future HAQ (p<0.0001). LDA at 4 mo was associated with less radiographic progression (OR, 95% CI: 0.49, 0.25-0.95, p=0.03) in complete cases. Other significant factors associated with higher HAQ included higher BSL HAQ, older age and female sex and factors associated with future joint damage were BSL damage and positive RF and anti-CCP. There were 118 patients from the OBRI cohort who had at least 2-year follow-up with available outcome. At BSL 13(11%) were in LDA defined by RADAI that improved to 43(36%) at 6 mo. Mean (sd) HAQ 1.31 (0.8) at BSL improved to 0.78 (0.7) at 2 years. Based on RAPID3, 11% were determined to be in LDA at BSL which increased to 22 (22%) at 6 mo. LDA at 6 mo, defined by either PROM, was significantly associated with lower HAQ at 2 years (p=0.03 for RADAI, p=0.05 for RAPID3 criteria). Other significant factors associated with higher HAQ included older age, BSL HAQ and gender (female).
Conclusion:
Achieving LDA as early as 4-6 months is associated with improved long-term outcomes in early RA. Disease status using PROMs seems to have significant predictive validity for future outcomes.
Disclosure:
P. Akhavan,
OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), the Ontario Ministry of Health and unrestricted grants from: Abbvie, Amgen, Bristol Myers Squibb, Pfizer, UCB, Janssen and Roche.,
2;
B. Jacob,
OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), the Ontario Ministry of Health and unrestricted grants from: Abbvie, Amgen, Bristol Myers Squibb, Pfizer, UCB, Janssen and Roche.,
2;
P. R. Fortin,
None;
G. A. Tomlinson,
None;
C. Bombardier,
OBRI,
2.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictive-validity-of-low-disease-activity-using-patient-reported-measures-on-long-term-outcomes-in-early-rheumatoid-arthritis-results-from-study-of-new-onset-rheumatoid-arthritis-and-ontario-best-p/