Background/Purpose: The impact of inadequate therapy behavior in rheumatoid arthritis (RA) patient outcomes may be amplified by the fact that almost all individuals with poor drug compliance, eventually drop out of treatment and out of the health care system completely. In 2004, we established an early arthritis clinic (EAC) in a referral centre for rheumatic diseases. Once enrolled in the inception cohort, recent-onset RA patients underwent regular evaluations that included disease activity and compliance with treatment that was indicated according to a ‘treat to target’ (T2T) strategy. Objectives 1.- To describe the characteristics of patients who dropped out of health care (HDO) in an ongoing cohort of patients with recent onset RA at inclusion. 2.- To explore baseline and cumulative predictors for HDO, with emphasis on disease activity, treatment and persistence with therapy (P) as potential cumulative predictors.

Methods: Charts from patients attending the EAC from 2004 onwards were reviewed. Patients with HDO (cases) were defined when they did not return back to the clinic for at least one year. Control swere defined if compliant with all their scheduled visits and included patients lost to follow-up but who returned to the EAC within one year since their last visit. Persistence with therapy (P) was defined as length of time patients complied with treatment. A case-control nested within a cohort design was used to compare baseline and cumulative (up to HDO or equivalent follow-up) variables between cases and paired (according to age [±5 years], sex, autoantibodies and follow-up to HDO or equivalent) controls. Cox regression analysis was used to investigate predictors of HDO. Patients provided written informed consent.

Results: Data from 170 patients (89.4% female, [mean±SD] age: 38.2±12.6 years) with ≥1 year of follow-up were analyzed; up to December 2015, (median, range) follow-up was 86.6 months (43.2-123) during which 35 (20.6%) patients had HDO after 41.1 months (12.1-58.7) of follow-up. Baseline and cumulative variables related to disease activity, treatment and P entered regression models; cumulative n° of flares (OR: 2.45, 95%CI: 1.35-4.4, p=0.003), n° of DMARD/patient (OR: 2.89, 95%CI: 1.58 -5.27, p=0.001) and P<50% (OR: 3.06, 95%CI: 1.29-7.29, p=0.011) emerged as predictors of HDO. Five cases returned back to the EAC after (median, range) drop out time of 3.8 years (2.3-5.8); they exhibited higher disability and poorer function than 15 paired controls (1:3) and these negative outcomes were sustained up to their last follow-up.

Conclusion: Failure to control disease activity, intensive treatment and poor P predicted HDO in an inception cohort of RA patients. HDO impacted patient´s outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-health-care-drop-out-in-an-inception-cohort-of-patients-with-early-onset-rheumatoid-arthritis/