FRI0106 Results of a systematic literature review of prognostic factors in rheumatoid arthritis as a basis for a prospective rheumatologists survey

Background Selecting the most appropriate therapy for each patient with rheumatoid arthritis (RA) is crucial in order to prevent joint damage, particularly in patients with rapidly progressing disease. The literature on prognostic factors is tremendous, being practical to summarize which factors are most strongly associated with a particular outcome and what is the utility that rheumatologists assign to these factors. Objectives To identify well established factors predicting long-term outcomes in RA, as the basis for a survey. Methods The identification of the factors was performed via an overview of systematic reviews studying prognostic factors in RA, followed by scoping reviews for individual factors. All searches were conducted in PubMed. In order to be included in the overview, the study had to be a systematic review of prognostic factors of any of the following outcomes: disability, mortality, remission, response to treatment, or radiological damage. All factors identified, in positive or negative association with the selected outcomes, were compiled in a matrix of factors * outcomes. Subsequent scoping literature reviews were performed for each combination of the matrix. Results The overview of systematic reviews allowed the identification of 36 prognostic factors (see Table 1). Table 1. Prognostic factors identified in the overview of systematic reviews Outcomes Prognostic factors Disability Genetic markers Genetic polymorphisms Quality of life index HAQ Mortality Genetic markers Shared epitope Medical history Lung disease No remission Medical history Clinical Presentation Advanced age Age at disease onset Duration of disease Tobacco Obesity Comorbidities Disease activity Monotherapy Biological treatment Response to treatment Biomarkers RF ACPA RFA IL2 RANKL Vitamin D Radiological data Residual synovitis by US Scintigraphy MRI Treatment Treat to target Remission No response to treatment Biomarkers Calprotectin RF Treatment Treatment Failure Structural damage Genetic markers Shared epitope Polymorphisms Radiological data Erosions Biomarkers Calprotectin RF ACPA Composite activity indices Treatment Minimum treatment Combination Therapy Effect Recruitment time in clinical trials After a round of discussions, we decided to remove all factors depending on treatment or study methodology for the scoping reviews, considering that they could not properly be considered prognostic factors but modifiers. Following the scoping reviews, we obtained a list of studies of prognostic factors, with methodological characteristics and 27 reviews of specific prognostic factors and outcomes. With this information, a survey addressed to practicing rheumatologists was developed to test how often they use the various factors to make long-term predictions, and how strong they think the association with outcome is. Conclusions We have analyzed and compiled a summary of prognostic factors published in RA and their predictability of long-term outcomes. This may act as a reference for cross-factor comparison and evidence-based risk assimilation and serve as a basis of surveying the value of such factors. Acknowledgements This study was funded by Bristol-Myers Squibb. Disclosure of Interest L. Carmona Grant/research support from: BMS, T. Otόn Grant/research support from: BMS, A. Royo Employee of: BMS, J. L. Baquero Grant/research support from: BMS, S. Luján: None declared, S. Muñoz-Fernández Grant/research support from: BMS