AB0261 TARGET SETTING OF FUNCTIONAL REMISSION FOR HAND AND WRIST SURGERIES USING GRIP POWER AND PATIENT-REPORTED OUTCOME MEASURES IN PATIENTS WITH RHEUMATOID ARTHRITIS: A PROSPECTIVE COHORT STUDY. (June 2019) - Ishikawa, Hajime
Abstract : Background: The treatment aim of rheumatoid arthritis (RA) is achieving and maintaining functional remission via tight medical control. However, if adequate medication is not administered in the very early stage of the disease, surgical reconstruction for the structurally damaged hand and wrist is sometimes required. Objectives: To evaluate the effect of surgical treatment of the hand and wrist (1) and to set the target of functional remission using grip power and patient-reported outcome measures (PROs) at baseline. Methods: A prospective observational cohort study was performed in RA patients who were scheduled to have primary hand and/or wrist surgeries. Assessments were performed at baseline and 12 months after surgery using grip power (GP), pain visual analogue scale (pain VAS), general health (GH), disease activity score 28- C-reactive protein(4) (DAS28-CRP(4)), disabilities of the arm, shoulder and hand (DASH), European quality of life scale with five dimensions (EQ-5D), Beck depression inventory -II (BDI-II) and health assessment questionnaire- disability index (HAQ-DI) for all registered patients. Baseline data for each item in the group with HAQ remission (HAQ-DI≤0.5) at 12 months (REM) were compared with those in the group without remission at 12 months (non-REM). Results: There were 137 sites (63 hands, 74 wrists) in 119 patients whose average age was 62 (19-88) years and average disease duration was 14 (1-45) years. Overall, the physical function (GP, pain VAS, DASH, HAQ-DI), quality of life (HAQ-DI, GH, EQ-5D), depression (BDI-II) and disease activity (DAS28-CRP(4)) had significantly improved at 12 months (p<0.01) (Table 1 ) . In the REM group (n=47), the GP and EQ-5D were significantly higher (p<0.01) and the HAQ-DI, DASH and BDI-II significantly lower (p<0.01) than in the non-REM group (Table 2 ) . The cut-off value at baseline for achieving HAQ remission at 12 months after surgery was 119 mmHg (sensitivity: 0.70, specificity: 0.64) in GP, 0.81 (0.81, 0.77) in HAQ-DI, 36.9 (0.74, 0.73) in DASH, 0.69 (0.87, 0.74) in EQ-5D and 9.5 (0.72, 0.60) in BDI-II. Conclusion: GP and other four PROs were validated as good objective tools for assessing the physical function after hand and wrist surgeries. It would be helpful for rheumatologists to consider the timing of surgery in RA patients based on the cut-offs determined in this study (2) . References: [1] Ishikawa H. The latest treatment strategy for the rheumatoid hand deformity. J Orthop Sci. 2017; 22: 583-592. [2] Kojima T, Ishikawa H, Tanaka S, et al. Target setting for lower limb joint surgery using the timed up and go test in patients with rheumatoid arthritis: A prospective cohort study. Int J Rheum Dis. 2018; 21: 1801-1808. In the other items, there was not a significant difference between two groups Disclosure of Interests: Hajime Ishikawa: None declared, Asami Abe: None declared, Toshihisa Kojima: None declared, Masayo Kojima: None declared, Yoichi Kurosawa: None declared, Eriko Hasegawa: None declared, Satoshi Ito Speakers bureau: Mitsubishi Tanabe Pharma Corporation., Naoki Ishiguro: None declared, Akira Murasawa: None declared