AB1181 The Impact of Physical Function on Patient Global Assessment in Rheumatoid Arthritis
Authors: T. Watanabe, T. Kojima, N. Takahashi, K. Funahashi, S. Asai, T. Takemoto, N. Asai, N. Ishiguro
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> In 2011 ACR/EULAR Boolean-based definition of remission in RA, patient global assessment (PGA) is often the limiting factor for reaching remission<sup>1</sup>. The main determinants for the PGA are pain, function, and number of swollen joints<sup>2</sup>. Physical functions will affair clinical remission. Given the tight correlation between physical function and loss of social and economic opportunities<sup>3</sup>, as well as clinical remission, functional remission is also an important goal. <h3>Objectives</h3> The aim of this study is to investigate the impact of physical function on PGA, and to clarify the predicting factor of functional and clinical remission. <h3>Methods</h3> 512 RA patients at Nagoya University Hospital were enrolled in this study. Physical function was assessed using Health Assessment Questionnaire (HAQ), disease activity DAS28-CRP, and PGA 0-10 visual analog scale. <h3>Results</h3> Patients were primarily women (81.4%). Mean age was 60.3±14.0 years, disease duration 13.0±10.4 years, HAQ-DI 0.67±0.75, and DAS28-CRP 2.37±1.02. HAQ-DI was getting worse in correlation with disease activity (r=0.452), and disease duration (r=0.446). In the early stage of RA (duration &lt;2 years), HAQ-DI was strongly correlated with DAS28-CRP (r=0.758). PGA had a most strong correlation with the HAQ-DI in the components of the DAS28-CRP (r=0.395). Of the patients who were in functional remission (HAQ-DI ≤0.5), mean PGA was 0.51, of the patients whose HQA-DI &gt;0.5; 4.2 (Fig. 1). 50.3% of the former fulfilled PGA 0 or 1, on the other hand, only 16.0% of the latter fulfilled PGA 0 or 1 (Fig. 2). 277 patients fulfilled swollen joint count, tenderness joint count, and CRP 1 or less.46.2% fulfilled Boolean-based remission, and 53.8% fulfilled three of four Boolean criteria except PGA. Mean HAQ-DI was the former 0.19, the latter 0.67, which showed a significant difference (Fig. 3). Cut off value was HAQ-DI=0.18 that satisfies PGA 0 or 1 by Receiver Operating Characteristic analysis of the 277 patients fulfilled swollen joint count, tenderness joint count, and CRP 1 or less (Fig. 4). Multivariate analysis revealed that disease duration independently predicted HAQ-DI≤0.18. <h3>Conclusions</h3> Physical function had an impact on PGA. Physical function was associated with disease activity, especially in the early stage. Cut off value that satisfies PGA 0 or 1 was HAQ-DI =0.18, which was stringent than the HAQ remission (≤0.5). Given that HAQ-DI was getting worse in correlation with disease duration, and disease duration independently predicted HAQ-DI≤0.18, early aggressive treatment is needed to achieve functional remission. <h3>References</h3> Studenic P, Smolen JS, Aletaha D. Near Misses of ACR/EULAR criteria for remission: effects of patient global assessment in Boolean an index-based definitions. Ann Rheum Dis 2012;71:1702-1705 Studenic P, Radnner H, Smolen JS, Aletaha D. Discrepancies between patients and physicians in their perceptions of rheumatoid disease activity. Arthritis Rheum 2012;64:2814-2823 Strand V, Khanna D. The impact of rheumatoid arthritis and treatment on patients9 lifes. Clin Exp Rheumatol 2010;28:S32-40 <h3>Disclosure of Interest</h3> T. Watanabe Speakers bureau: Janssen Pharmaceutical, T. Kojima Grant/research support from: Takeda Pharma Corporation, Janssen Pharmaceutical, and Astellas Pharma Corporation, Speakers bureau: Mitsubishi Tanabe Pharma Corporation, Takeda Pharma Corporation, Eisai Pharma Corporation, N. Takahashi: None declared, K. Funahashi: None declared, S. Asai Speakers bureau: Eisai Pharma Corporation, T. Takemoto: None declared, N. Asai: None declared, N. Ishiguro Grant/research support from: Daiichi Sankyo, Takeda Pharmaceutical, Hisamitsu Pharmaceutical, Speakers bureau: Daiichi Sankyo, Takeda Pharmaceutical, Hisamitsu Pharmaceutical, Otsuka Pharmaceutical,