SAT0130 Improvement of nutritional conditions in patients with rheumatoid arthritis starting first disease modifying anti-rheumatic drugs
Authors: D. Kobayashi, S. Ito, E. Hasegawa, I. Narita, K. Nakazono
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Rheumatoid arthritis(RA) is a chronic inflammatory condition, and has been associated with adecreased life expectancy. Although life expectancy has improved in many RA patients recently, the reason for this is not entirely clear. <h3>Objectives</h3> We hypothesized that better disease activity control of RA led to relief from chronic inflammation, which resulted in better nutritional conditions, and contributed to a longer life expectancy. The aim of this analysis was to examine the relationship between RA disease control and the improvement of nutritional conditions. <h3>Methods</h3> We analyzed data obtained from 111 patients with RA (male 44, female 67) who were referred to our hospital and received first disease modifying anti-rheumatic drugs (DMARD) in 2016 and 2017, retrospectively. The patient data were obtained retrospectively from medical records for a 6-month period starting at the date DMARDs were initiated. We chose serum albumin (Alb), total lymphocyte count(TLC), and hemoglobin (Hb) concentration, as the indicators of the nutritional condition. Furthermore, D-values and nutrition index 40 (N.I.40), indicators of anastomotic leakage after gastrointestinal surgery were also analyzed.Comparisons between the two groups were performed using Mann-Whitney U test. Comparisons between the parameters at different time points were performedusing <i>Wilcoxon signed-rank test</i>. The association among the ordered European League Against Rheumatism (EULAR) response rate and the magnitude ofimprovement in the nutritional condition were analyzed by using the Jonckheere-Terpstratest. Data on each patient's age and duration of RA were calculated as median(IQR<sub>1/4</sub>-<sub>3/4</sub>) values. <h3>Results</h3> The patient age was 64.0 (54.0-74.5) years, and the duration of RA was 3.0 (1.0-7.0) months. Oral prednisolone (PSL) was used in 51 patients. Other drugs administered to patients over the 6-month period included: methotrexate (63 patients), iguratimod (42 patients), bucillamine (29 patients), sulfasalazine (25patients), tacrolimus (6 patients), and bDMARD (13 patients). The level of C-reactiveprotein (CRP) and the disease activity score for 28 joints based on theerythrocyte sedimentation rate (DAS28-ESR) before and 6 months after the initiation of DMARD treatment improved from 0.50 (0.12-1.7) mg/dL to 0.10 (0.010-0.20),p&lt;0.001, and from 4.62 (3.51-5.52) to 2.52 (1.53-3.13), <i>p&lt;0.001</i>,respectively. The EULAR good response was achieved in 59 patients, and moderate response was achieved in 31 patients. Serum Alb level, Hb concentration, D-value, and N.I.40 showed significant improvement 6 months after the starting of DMARD [3.9 (3.6-4.3) vs 4.2 (4.0-4.5) mg/dL, <i>p&lt;0.001</i>; 12.5 (11.7-13.4) vs 12.6 (11.8-13.6) g/dL, <i>p=0.0164</i>; 0.155 (-0.47- 0.91) vs -0.26 (-0.72-0.18), <i>p&lt;0.001</i>; 47.2 (41.8-51.1) vs 49.8(46.1-52.2), <i>p&lt;0.001</i>,respectively]. Furthermore, we found a significant trend towards improvement of serum Alb level, Hb concentration, D-value, and N.I. 40 in patients with a better EULAR response (<i>p</i> value for trend=0<i>.0124, 0.033, 0.0057,</i> and <i>0.0040</i>, respectively). <h3>Conclusions</h3> There was a statisticallysignificant trend towards better nutritional improvement in patients with a better EULAR response. Control of RA may contribute not only to joint deterioration prevention, but may also help to improve the nutritional condition of patients. <h3>Disclosure of Interest:</h3> None declared