AB1322 DEPRESSION IN ESTABLISHED RHEUMATOID ARTHRITIS; MULTICENTER PROSPECTIVE COHORT STUDY FOR EVALUATION OF JOINT SURGERY ON PATIENT’S REPORTED OUTCOME
Authors: Toshihisa Kojima, Masayo Kojima, Hajime Ishikawa, Sakae Tanaka, Keiichiro Nishida, Nobuhiko Haga, Yukio Masaoka, Jun Hashimoto, Hisaaki Miyahara, Yasuo Niki, Tomoatsu Kimura, Hiromi Oda, Shuji Asai, Koji Funahashi, Naoki Ishiguro
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Loss of physical function is a clinical feature of RA. Total management including reconstructive joint surgery and rehabilitation should be needed for further improvements of physical function for established RA patients. In these days, it is very important to evaluate the effectiveness of joint surgery as well as drug therapy based on patient-reported outcome (PRO). <h3>Objectives</h3> The purpose of this study is to explore the relationship among depression, clinical variables and other PROs including physical function and improving of depressive status with joint surgery. <h3>Methods</h3> Multicenter prospective observational cohort study was conducted among patients who underwent elective joint surgery for RA from April 2012 to March 2016 (Study registration: UMIN000012649) (ref.1). In this study, we collected data at baseline and at 6 or 12 months after the surgery. These data were as follow; age, sex, disease duration, drug therapies, and disease activity (DAS28-CRP), and PRO measures [HAQ-DI, EQ-5D (QOL), pain VAS and BDI-II (depression)]. Correlation between BDI-II and other variables were determined using multiple liner regression analysis with forward stepwise. <h3>Results</h3> Totally, 346 patients before elective joint surgery were analyzed cross-sectionally. Mean age, disease duration, pain(VAS), DAS28, HAQ-DI, EQ-5D and BDI-II were 64.2 years, 17.0 years, 36.2 mm, 3.02, 1.111, 0.641 and 13.0, respectively. 52.6% of elective joint surgeries were in upper limbs and 47.4% were in lower limbs. Multiple liner regression analysis showed that HAQ-DI [β:-0.48, p&lt;0.001] pain VAS(β:-0.26, p&lt;0.001) and BDI-II (β:-0.19, p&lt;0.001)were independent factors for EQ-5D. Furthermore, HAQ-DI (β: 0.31, p&lt;0.001) and pain VAS (β: 0.17, p=0.002) had significant impact on BDI-II. Especially, walking (β: 0.12, p&lt;0.001) and eating (β: 0.16, p=0.005) were independent factors for BDI-II in HAQ-DI categories. As longitudinal analyses (n=138), mean BDI-II was significantly improved from 12.1 at baseline to 10.5 at last observation (6 or 12 months) after joint surgery in lower limbs (paired t-test, p&lt;0.001). Change in HAQ-DI (β: 0.23, p=0.031) had significant impact on that in BDI-II. The improving in walk category (β: 0.21, p=0.012) was a relevant factor for improving of BDI-II after the surgery. <h3>Conclusion</h3> Loss of physical function is an important factor for impairment of depressive status as well as QOL in established RA patients. Improving of physical function with joint surgery in lower limbs caused improving of depressive status. Rheumatologists should take the joint surgery into consideration as effective intervention for treatment of established RA patients. <h3>References</h3> [1] Kojima T, et al. Int J Rheum Dis. 2018. doi: 10.1111/1756-185X.13394. <h3>Acknowledgement</h3> The registry used in this study was supported by a grant from the Ministry of Health, Labour and Welfare (H2424YN002-00) to Naoki Ishiguro <h3>Disclosure of Interests</h3> Toshihisa Kojima Grant/research support from: Chugai Pharmaceutical (Investigator Initiated Study), Novartis, Nippon Kayaku, Eli Lilly, Eisai, Speakers bureau: Chugai Pharmaceutical, Takeda Pharmaceutical, Pfizer, Eli Lilly Japan, Bristol Myers Squibb, Ono Pharmaceutical, Daiichi Sankyo, Astelas, UCB, Janssen Pharmaceutical, Tanabe Mitsubishi, Masayo Kojima: None declared, Hajime Ishikawa: None declared, Sakae Tanaka Grant/research support from: KYOCERA Corporation and Asahi Kasei Corporation, Consultant for: Amgen Astellas BioPharma K.K., KYOCERA Corporation, Pfizer and Daiichi Sankyo Co., Ltd., Speakers bureau: Asahi Kasei Corporation, Astellas Pharma Inc, Ayumi Pharmaceutical Corporation, Eisai Co., Ltd., Ono Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd, Taisho Toyama Pharmaceutical Co., Ltd., Mitsubishi Tanabe pharma Corporation, Chugai Pharmaceutical Co., Ltd., Teijin Pharma Ltd., Eli Lilly, Hisamitsu Pharmaceutical Co, Inc., Pfizer, Bristol-Myers., Keiichiro Nishida: None declared, Nobuhiko Haga: None declared, Yukio Masaoka: None declared, Jun Hashimoto: None declared, Hisaaki Miyahara: None declared, Yasuo Niki: None declared, Tomoatsu Kimura: None declared, Hiromi Oda: None declared, Shuji Asai Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Janssen, Takeda, and UCB Japan, Koji Funahashi: None declared, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant for: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama