AB0310 Using treat-to-target strategy by determining physical disability and glucocorticoid reduction strongly influence functional remission in rheumatoid arthritis
Authors: T. Hagiwara, K. Kamada, N. Namura
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The initial target in the treatment of rheumatoid arthritis (RA) is to achieve clinical remission (CR) through Boolean definition and/or index-based criteria and sustain CR, and the final target is to maximise long-term health-related quality of life (HRQoL) through arthritis control, joint damage prevention, function normalisation and social participation.<sup>1</sup> <h3>Objectives</h3> We aimed to determine the factors that inhibit the achievement of functional remission (FcR) in terms of HRQoL. <h3>Methods</h3> A total of 227 patients with RA who had underwent first treatment between October 2014 and December 2017 and had not changed/added another disease-modifying anti-rheumatic drugs (DMARDs) for 12 weeks before the observation day were examined. We used daily-life function and social activity participation to evaluate HRQoL. We adopted the Health Assessment Questionnaire Disability Index (HAQDI) as daily-life functional assessment and EuroQoL 5 dimensions–5 levels (EQ5D) for health status with considerable potential assessment. FcR was defined in this study as HAQDI ≤0.5 and EQ5D≥0.867 "0.867 is the lowest QoL score when only one category permits ≤2 of the 5 levels, but others need 1 in all five categories". We investigated their age at RA onset, sex, Steinbrocker stage and functional class, HAQDI, disease activity level, rheumatoid factor, anti-cyclic citrullinated peptide antibody at the first consultation, age, disease activity level, HAQDI, EQ5D, and status of methotrexate (MTX), glucocorticoids (GCs) and biologic/target synthetic DMARD (b/ts-DMARD) use at the last observational day. First, the assumed remissions were analysed using the FcR as a purpose variable for these factors. Subsequently, the odds ratio and 95% confidence interval (95% CI) were examined using multiple logistic regression analysis for the statistically significantly different factors and risk factors. <h3>Results</h3> The CR achievement rate at the last observational day by Boolean definition and Simple Disease Activity Index were 40.5% and 50.2%, respectively. The achievement ratio of HAQ-DI ≤0.5, EQ5D≥0.867 and FcR was 73.1%, 48.5%, and 46.7%, respectively. The differences in disease duration, stage, class and HAQDI at the time of the first interview; state of MTX, GCs and b/ts-DMARD use; and age at the last observational day for the achievement of FcR were statistically significant. The odds ratios, as determined by multiple logistic regression analysis of the above-mentioned results, were 1.034 (95% CI 0.982–1.088, p=0.202) for disease duration (per 1 year), 1.576 (95% CI 1.257–1.977, p&lt;0.001) for HAQDI at first interview (per 0.5), 0.615 (95% CI 0.277–1.365, p=0.232) and 4.943 (95% CI 1.683–14.524, p&lt;0.01) for GCs state (non-use vs temporal use and non-use vs continuous use, respectively), and 1.164 (95% CI 1.037–1.307, p&lt;0.05) for age at last observational day. <h3>Conclusions</h3> HRQoL is important as they will influence future treatment strategy. Our results indicated the importance of functional assessment at first interview and demonstrated how to use GCs for the treatment of RA. Ageing always contributes to patients' frailty, and it is unavoidable it. To achieve FcR, functional assessment should be performed during the first interview and short-term use of GC is useful for prompt functional recovery, in consideration of ageing. <h3>Reference</h3> [1] de Wit MP, et al. ARD2011;70(6):891–895. doi:10.1136/ard.2010.14662 <h3>Disclosure of Interest</h3> None declared