AB0290 TREAT-TO-TARGET (T2T) IS NOT ENOUGH: IDENTIFY FACTORS LEADING TO A MISMATCH BETWEEN T2T AND HAQ AMONG RA PATIENTS THROUGH DATA MINING FROM SMART SYSTEM OF DISEASE MANAGEMENT (SSDM)
Authors: Jing Yang, Yongfu Wang, Hua Wei, Yu Zhang, Xiaoling Liu, Xiaofeng Rong, Jinmei Zou, Xiaofei Shi, LI Hongbin, Hui Xiao, Yuhua Jia, Fei Xiao, Zhenbiao Wu
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> T2T, achieving a DAS28 score lower than 2.6 (remission) or below 3.2 (low disease activity), is the main management strategy recommended by ACR and EULAR. HAQ is the most widely used in assessments of physical function in RA. However, the T2T may not always associate with good HAQ. <h3>Objectives</h3> To quantify phenomenon of mismatch between the T2T and the HAQ in RA patients and identify influential factors from real-world data mining in SSDM. <h3>Methods</h3> SSDM is a novel mobile tool of disease management. The patients were trained to master SSDM by health care professionals and conducted their DAS28 and HAQ self-assessments. The data were synchronized to the mobile of physicians and uploaded onto cloud for analysis. <h3>Results</h3> From Jun 2014 to Jan 2019, 44,698 RA patients from 587 hospitals in China used SSDM, of which 32,058 patients made 67,845 DAS28 and HAQ self-assessments. The T2T rates were 27% at baseline, and 60% after 6 months among 4,768 patients who have been followed up longer than 6 months. In 25,820 assessments of patients who achieved T2T at baseline or repeat assessments, 76% (19,552) assessments had normal physical function (HAQ = 0), but 24% (6,268) were with HAQ score higher than 0, which mean score for 8 functional tests was 3.67, indicating physical dysfunction. The “Bend down to pick up clothing from the floor” was the one being affected most, with a mean score of 0.81, significantly higher than other functional test score, P&lt;0.001. The mean numbers of tender and swollen joints among T2T patients were 1.53 and 1.32 respectively. The analysis of correlation between physical dysfunction and the affected joints showed the knees were the major contributor to the mismatch, following by wrist and shoulders. Table 1 showed the mean scores for each functioning category in HAQ and the top target joints. In patients who did not achieve T2T, 32% had HAQ scores of 0, showing that these patients had normal physical function despite failure in achieving T2T. The mean number of tender and swollen joints in these patients was 4.31 and 2.85, respectively. The affected joints were mainly hand joints. According to the cluster weights for the impacts of affected joints on physical function, the weighted coefficient of affected joints impacting factors (IF) on physical function was obtained. The highest IF was for knee (4), followed by wrist (3.4), shoulder (2.3), middle finger (2.1), elbow (2), index finger (2), other fingers (1), respectively. <h3>Conclusion</h3> 1/4 RA patients suffer from physical dysfunctions even though T2T are achieved. Diseased knees, wrists and shoulders are the top three joints that lead to corresponding physical dysfunctions and contribute to a mismatch between T2T and HAQ. Conversely, diseased elbow and finger joints are less likely to cause physical dysfunction. Therefore, not all joints are equal. Joints of knees, wrists and middle fingers deserve higher IF (2.1-4) in evaluation of disease activity. T2T guided by current DAS28 lead to mismatch with HAQ and may be misleading. A modified DAS28 should be considered with IF and a special attention should be paid on these top three joints for rehabilitations. <h3>Disclosure of Interests</h3> None declared