SAT0110 Trajectories of functional disability in patients with early inflammatory polyarthritis and moderate disease activity: results from the early rheumatoid arthritis network and norfolk arthritis register. (12th June 2018)

• Record Type: Journal Article
• Authors: Norton, S.; Gwinnutt, J.; Pan, Y.; Symmons, D.; MacGregor, A.; Young, A.; Kiely, P.; Walsh, D.; Verstappen, S.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 917
• Page End: 918
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.4184
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: A large group of patients with inflammatory polyarthritis (IP), and its subset rheumatoid arthritis (RA), have moderate disease activity, despite disease modifying therapy. Identifying patients with moderate disease who are likely to have subsequent high disability may prompt different treatment strategies for these patients. Objectives: To identify common trajectories of disability progression in patients with moderate disease in two large prospective observational studies. Methods: The Early Rheumatoid Arthritis Network (ERAN) recruited 1236 patients with RA (<36 months symptoms) from 23 centres in England from 2002-11. The Norfolk Arthritis Register (NOAR) recruited 1054 IP patients (<24 months symptoms) from Norfolk, England, from 2000-8. At baseline and subsequent follow-ups, functional disability was assessed using the Health Assessment Questionnaire (HAQ). Included patients scored ≥3.2 and <5.1 on the Disease Activity Score (DAS28) at either baseline, year 1 or year 2, and had previously received csDMARDS (NERAN =605; NNOAR =407). Latent class growth models (LCGMs) were used to identify HAQ trajectories independently in each cohort. Age, sex, fulfilment of ACR RA criteria, symptom duration, DMARDs at baseline, and baseline DAS28 were included as predictors of trajectory group membership using multinomial logistic regression. Results: Baseline characteristics of the cohorts were similar (ERAN vs NOAR: mean age = 57 vs 56 years; female = 70% vs 69%; met ACR criteria = 88% vs 77%; mean DAS28 = 4.7 vs 4.2). For both cohorts, LCGM analysis indicated 4 subgroups provided best fit (Bayesian Information Criterion), with similar shaped trajectories (figure 1). Multinomial logistic regression indicated that older age (ERAN & NOAR, p<0.005), female gender (ERAN & NOAR, p<0.01), meeting ACR criteria (NOAR only, p<0.05), use of DMARD (ERAN & NOAR, p<0.01), and baseline DAS28 (ERAN & NOAR, p<0.005) were related to an increased likelihood of being in a subgroup with higher disability (vs. lowest disability subgroup). Conclusions: Four disability trajectories were observed in both the ERAN and NOAR cohort of patients with moderate disease activity. Patients on a worse trajectory who may benefit from more intensive treatment could potentially be identified earlier in the disease the group of patients with moderate disease activity. Reference: [1] This research was funded by Arthritis Research UK. Disclosure of Interest: None declared