AB0288 PERSISTENTLY ACTIVE DISEASE IN PATIENTS WITH NEW-ONSET RHEUMATOID ARTHRITIS DURING THE FIRST YEAR OF TIGHT CONTROL AND AGGRESSIVE THERAPY: PREVALENCE AND CLINICAL PREDICTORS IN DIFFERENT CRITERIA SETS

Wenhui Xie, Xiaoying Sun, Zhuoli Zhang
2019 Abstracts Accepted for Publication   unpublished
Early intervention and aggressive therapy of rheumatoid arthritis (RA) improves prognosis, however a substantial proportion of patients under guideline-based care remain persistently active disease (PAD) in the first year. Objectives: To investigate the proportion of PAD (LDA/MDA/HDA) in reallife practice and identify its prognostic factors in early RA (£2 years) patients receiving tight-controlled conventional synthetic disease-modifying antirheumatic drugs (csDMARD) treatment at 1 year of
more » ... ow-up. Methods: In our observational RA cohort, patients were usually threemonthly followup and step-up csDMARD escalation treatment at the discretion of physicians in the first year. Disease activity and remission were assessed by four commonly-used indices (DAS28-ESR, CDAI, SDAI, and Boolean criteria). Logistic regression was used to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) for PAD by 12 months. Results: The study included 303 DMARD-naïve early RA patients completing one year follow-up schedule, who were mostly female (72%) with a mean age of 55, and a median disease duration of 6 months. Most patients were in MDA or HDA at baseline and most of them (83.5%) received csDMARDS combination in the first year. 26.4-55.1% of participants did not reach remission by 12 months. Compared to patients experienced remission, patients in PAD were frequently in female, elder, shorter disease duration, and high baseline disease activity components, including SJC, TJC, PGA, EGA, ESR, CRP and glucocorticoids use. In multivariate logistic regression analyses, female (OR=1.34-1.58), increasing age (OR=1.03-1.10), longer disease duration (OR=1.45-1.78), higher baseline SJC (OR=1.11-1.25), EGA (OR=1.02-1.08) showed the independent association with the increased risk for PAD, across all criteria. Higher ESR (OR=1.05) was an independent risk factor for PAD, measured by DAS28-ESR. Conclusion: Our results indicated around one-third of RA participants receiving guideline-based healthcare had PAD in the first year. Female, increasing age, long disease duration, higher SJC, EGA, and ESR at baseline independently increased the risk of PAD.
doi:10.1136/annrheumdis-2019-eular.947 fatcat:3lqnu762k5appg2witu4n4nkve