AB0229 What warrant comprehensive disease remission (CDR) at long term? – probability of das28-crp remission at six months –
Authors: I. Yoshii
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Comprehensive disease remission (CDR) for rheumatoid arthritis (RA) patient is an ultimate challenge in treatment. Several reports suggested initial treatment is essential for attaining CDR, what means it is necessary to indicate clinical remission in the first treatment year. <h3>Objectives</h3> Aim of this study is to clarify how initial treatment until 6 months affect on CDR fulfilment, and whether patient's basic background influences. <h3>Methods</h3> We have 441 RA patients who had been treated consecutively for more than four years. These patients were recruited. Parameters such as 28-joints disease activity score with C-reactive protein (DAS28-CRP), modified Health Assessment Questionnaire Disability Index (mHAQ), pain score with visual analogue scale (PS-VAS), were monitored at every visit since first time. Sharp/van der Heijde Score (SHS) was calculated at first visit and every another year period. Average value of DAS28-CRP, mHAQ in fourth treatment year, and average progression of SHS per year (dSHS) were used to make judgment for CDR at fourth year, whether DAS28-CRP less than 2.3, mHAQ less than 0.5, and dSHS less than 0.5. Fulfilment of CDR is evaluated for patient's age, DAS28-CRP, mHAQ, SvdHS, and PS-VAS at first visit and sixth month was evaluated statistically with binary logistic regression analysis (BLR). Patient's background data at first visit were also evaluated in the same manner. For the significant factors, relationship with the background data was also evaluated with multivariate linear regression analysis (MLR). Statistical significance in both analyses was set below 5%. Receiver operating characteristic curve analysis (ROC) was also implicated for the significant factors. <h3>Results</h3> Because of lacking data, 310 patients were analysed. 146 (47.1%) of them had fulfilled CDR at fourth treatment year. Statistically significant factor for fulfilling CDR was mHAQ at first visit (odds ratio; 0.032, 95% CI; 0.008–0.139) and DAS28-CRP at sixth months (odds ratio; 0.273, 95% CI; 0.112–0.662). The mHAQ score at first visit correlated significantly with age at onset and first visit, patient's global assessment (PGA), CRP, and PS-VAS at first visit, whereas the DAS28-CRP score at sixth month correlated significantly with being male, tenderness joint count (TJC), physician's global assessment (EGA), CRP, and PS-VAS at first visit, and less reduction of TJC, swollen joint count (SJC), EGA, and CRP. Cut off point for each factor was 0 for mHAQ with 100% in sensitivity and 73.5% in specificity, whereas 1.105 for DAS28-CRP with 100% in sensitivity and 55.2% in specificity, which were used with ROC analysis. <h3>Conclusions</h3> These results suggest that treatment with treat-to-target (T2T) strategy, that aims clinical remission in three to six months from starting treatment, is available for attaining CDR. However, T2T is not enough for sustaining CDR in a long term. In order to fulfil and sustain CDR, basic background of the patient, such as age at onset and PGA, CRP, and PS-VAS, and age at first consult, is important factor. Therefore, CDR is not ultimate target at all for every RA patient <h3>Disclosure of Interest</h3> None declared