Treat-to-Target (T2T) Is Not Enough: Identify Factors Leading to a Mismatch between T2T and HAQ Among RA Patients through Data Mining from Smart System of Disease Management (SSDM)

Jing Yang¹, Hua Wei², Jianlin Huang³, Wenqiang Fan⁴, Hongzhi Wang⁵, Yongfu Wang⁶, Rong Mu⁷, Chun Li⁸, Jinmei Zou¹, Yu Zhang¹, Bin Wu⁹, Jianling Dong¹, Xiaofei Shi¹⁰, Xinwang Duan¹¹, Jianhong Wu¹², Fang He¹³, Hong Liu¹, Zhijun Li¹⁴, Guosheng Wang¹⁵, Shengguang Li¹⁶, Bei Wang¹⁷, Yanjie Hao¹⁸, Huiqiong Zhou¹⁹, Haili shen²⁰, Yang Cui²¹, Wenhui Huang²², Qing-chun Huang²³, Hui Xiao²⁴, Yuhua Jia²⁴, Fei Xiao²⁴ and Feng-Chun Zhang²⁵, ¹Department of rheumatology, Central Hospital of MianYang, Sichuan, Mian Yang, China, ²Northern Jiangsu People's Hospital, Yangzhou, China, ³Department of rheumatology, The Sixth Hospital Affiliated to Sun yat-sen University, Guangzhou, China, ⁴Department of rheumatology, Central Hospital of XinXiang, Henan, XinXiang, China, ⁵The First Hospital of Jiaxing, Jiaxing, China, ⁶The First Affiliated Hospital of BaoTou Medical College, Baotou, China, ⁷Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China, ⁸Peking University People's Hospital, Beijing, China, ⁹Department of Rheumatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China, ¹⁰The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China, ¹¹Department of rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, China, ¹²Dazhou Central Hospital, Dazhou, China, ¹³Central Hospital of Sui Ning, Sichuan, Suining, China, ¹⁴The First Affiliated Hospital of Bengbu Medical College, Bengbu, China, ¹⁵Department of rheumatology, Anhui Medical University Affiliated Provincial Hospital, Hefei, China, ¹⁶Peking University International Hospital, Beijing, China, ¹⁷Beijing Hospital of Traditional Chinese Medicine (TCM), Beijing, China, ¹⁸The First Affiliated Hospital of Beijing University, Beijing, China, ¹⁹The First Affiliated Hospital of PLA General Hospital, Beijing, China, ²⁰Department of Rheumatology and Immunology, Second Hospital of Lanzhou University, lanzhou, China, ²¹Guangdong General Hospital, Guangzhou, China, ²²The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China, ²³Rheumatology, Guangzhou Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China, ²⁴Shanghai Gothic Internet Technology Co., Ltd., Shanghai, China, ²⁵Peking Union Medical College Hospital, Beijing, China

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Disease Activity, Health Assessment Questionnaire, physical function and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: T2T, achieving a DAS28 score lower than 3.2 is the main management strategy recommended by ACR and EULAR. HAQ is the most widely used in evaluation of physical function in RA. However, T2T may not always associate with good HAQ. Our purpose is to quantify phenomenon of mismatch between T2T and HAQ in RA patients, identify influential factors from real world data mining in smart system of disease management (SSDM).

Methods: SSDM is a novel mobile tool of disease management. The patients were trained to master SSDM by health professionals and conducted DAS28 and HAQ self-evaluations once a month. The data were synchronized with their physicians and uploaded onto cloud for analysis.

Results: From June 2014 to June 2018, 31,230 RA patients from 587 hospitals in China used SSDM, of which 22,862 patients made 42,498 DAS28 and HAQ self-evaluations. The T2T rates were 29% at baseline (n=22,862) and 58% after 6 months (n=4,783).

In patients who achieved T2T, 76% had normal physical function (HAQ = 0), but 24% were with HAQ score higher than 0 with mean score 0.46, indicating physical dysfunction. The "Bend down to pick up clothing from the floor" was the move being affected most, with a mean score of 0.81, significantly higher than other dysfunctions, P<0.001. The mean numbers of tender and swollen joints among T2T patients were 1.53 and 1.32 respectively. The analysis of correlation between physical dysfunction and the affected joints showed the knees were the top targets. Table 1 showed the mean scores for each functioning category in HAQ and the top 3 target joints.

In patients who did not achieve T2T, 32% had HAQ scores of 0, showing that these patients had normal physical function despite failure in achieving T2T. The mean number of tender and swollen joints in these patients was 4.31 and 2.85, respectively. The affected joints were mainly hand joints.

According to the cluster weights for the impact of impact joints on physical function, the weighted coefficient of affected joints impacting on physical function was obtained. The highest score was for knee (0.46), followed by wrist (0.35), middle finger (0.19), index finger (0.18), shoulder (0.15), ring finger (0.13), elbow (0.09) and little finger (0.07).

Conclusion: 1/4 RA patients suffer physical dysfunctions even though T2T are achieved. Diseased knees, wrists and middle fingers are the top 3 joints critically impacting on corresponding physical dysfunctions and contribute to a mismatch between T2T and HAQ. Conversely, diseased shoulder, elbow and other small hand joints are less likely resulting in physical dysfunction. Therefore, not all joints are equal, and joints of knees, wrists and middle fingers deserve higher weighing coefficient in evaluation of disease activity. T2T guided by DAS28 is not good enough and may misleading. A modified DAS28 should be considered for overcome the mismatch with HAQ and a special attention should be paid on these top three joints for rehabilitations.

Disclosure: J. Yang, None; H. Wei, None; J. Huang, None; W. Fan, None; H. Wang, None; Y. Wang, None; R. Mu, None; C. Li, None; J. Zou, None; Y. Zhang, None; B. Wu, None; J. Dong, None; X. Shi, None; X. Duan, None; J. Wu, None; F. He, None; H. Liu, None; Z. Li, None; G. Wang, None; S. Li, None; B. Wang, None; Y. Hao, None; H. Zhou, None; H. shen, None; Y. Cui, None; W. Huang, None; Q. C. Huang, None; H. Xiao, None; Y. Jia, None; F. Xiao, None; F. C. Zhang, None.

To cite this abstract in AMA style:

Yang J, Wei H, Huang J, Fan W, Wang H, Wang Y, Mu R, Li C, Zou J, Zhang Y, Wu B, Dong J, Shi X, Duan X, Wu J, He F, Liu H, Li Z, Wang G, Li S, Wang B, Hao Y, Zhou H, shen H, Cui Y, Huang W, Huang QC, Xiao H, Jia Y, Xiao F, Zhang FC. Treat-to-Target (T2T) Is Not Enough: Identify Factors Leading to a Mismatch between T2T and HAQ Among RA Patients through Data Mining from Smart System of Disease Management (SSDM) [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/treat-to-target-t2t-is-not-enough-identify-factors-leading-to-a-mismatch-between-t2t-and-haq-among-ra-patients-through-data-mining-from-smart-system-of-disease-management-ssdm/. Accessed .

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