THU0105 Relationship between das28 categories and raid patient reported outcome in rheumatoid arthritis; significant advantage of targeting das remission
Authors: C. Smith, M. Sharif, A.A. Prideaux, P.D. Kiely
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> EULAR/ACR guidelines recommend remission or low DAS28 as the treat to target goal for patients with rheumatoid arthritis (RA). The DAS28 is a composite score derived from objective (swollen joint count and ESR/CRP) and subjective (tender joint count and patient global) measures of disease activity, restricted to 28 joints. It has been criticised as not being representative of the whole patient or completely allied to patient experience. Alternative patient reported outcomes (PROM) have been developed, including the rheumatoid arthritis impact of disease (RAID) which is a self-reported index which assesses seven domains by visual analogue scale: pain, disability, fatigue, sleep, coping, physical and emotional well-being. Responses are weighted differently producing a final score from 0–10 and a score &lt;2 is considered a patient-acceptable status. <h3>Objectives</h3> Given uncertainty over the necessity to aim for DAS remission (RDAS) as opposed to low DAS (LDAS) as a treatment target, we sought to explore the relation between DAS outcomes and RAID scores in routine clinical practice. <h3>Methods</h3> RA patients attending for routine review in the outpatient clinic at St George's Hospital were assessed by a physician associate between <sup>June 2016</sup> and September 2017. DAS28 CRP and ESR scores were recorded and RAID questionnaires completed by patients and calculated using the on-line EULAR tool. Data were analysed on Excel for summary statistics and Spearman correlation coefficient and socscistatistics.com for Mann-Whitney U tests. <h3>Results</h3> 117 RA patients were assessed, 84% female, mean age 59.6 years, 77% RF positive and 85% ACPA positive. The prevalence of DAS28 ESR categories was RDAS (≤2.6) n=57 (49%), LDAS (2.6–3.2) n=17 (14.5%), moderate (MDAS 3.21–5.1) n=35 (30%), high (HDAS ≥5.1) n=8 (6.5%). RAID scores correlated strongly with patient global (r=0.62), DAS28 CRP (r=0.58) and DAS28 ESR (r=0.54) but poorly with tender joint count (r=0.32), swollen joint count (r=0.10), ESR (r=0.13) and CRP (r=0.09). The mean RAID score in DAS28 ESR categories was RDAS 2.49, LDAS 3.77, M+HDAS 5.92, see figure 1, box and whisker plots. RAID scores were significantly different (Mann-Witney U) between M+HDAS versus RDAS (p&lt;0.0001), M+HDAS versus LDAS (p=0.0048) and also between RDAS versus LDAS (p 0.013). Similar significant differences in RAID scores were found with DAS28 CRP categories. There were no significant differences in RAID scores between RF positive versus negative or ACPA positive versus negative patients. Of 30 patients with RAID &lt;2, DAS28 ESR was &lt;2.6 in 27 (90%) and &lt;3.2 in 29 (97%). Of 74 patients with DAS28 ESR &lt;3.2, RAID was &gt;2 in 45 (61%) with fatigue followed by sleep being the worst scoring domains. <h3>Conclusions</h3> RAID scores strongly correlate with patient global and total DAS28 (ESR or CRP) scores, and are significantly different between all DAS categories, including RDAS versus LDAS. Patients with RAID &lt;2 are almost all at LDAS target, but high numbers at LDAS have unacceptable RAID, largely driven by high fatigue and sleep scores. This suggests that achieving RDAS has significant benefit over LDAS from a PROM perspective, and attention should be paid to fatigue and sleep if RAID is unacceptable in LDAS patients. <h3>Disclosure of Interest</h3> None declared