FRI0047 STRATEGIES REGARDING GOAL SETTING AND SELF-MANAGEMENT IN DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS: PRELIMINARY RESULTS OF A SYSTEMATIC LITERATURE REVIEW INFORMING THE 2020 EULAR RECOMMENDATIONS FOR THE MANAGEMENT OF DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS
Authors: N. M. T. Roodenrijs, A. Hamar, M. Kedves, G. Nagy, J. M. Van Laar, D. Van der Heijde, P. Welsing
Journal: Annals of the Rheumatic Diseases (2020)

Background: Rheumatoid arthritis (RA) patients treated according to European League Against Rheumatism (EULAR) recommendations failing ≥2 biological or targeted synthetic disease-modifying antirheumatic drugs with a different mode of action who still have complaints which may be suggestive of active disease and for whom management is perceived as problematic by patient and/or rheumatologist have been defined as suffering from ‘difficult-to-treat RA’. A mismatch in goal setting between patient and health care professional, and suboptimal self-management may contribute to this disease state, while specific management recommendations regarding these factors are currently lacking. 1 Objectives: To systematically summarise evidence in the literature on the identification and optimisation of a mismatch in goal setting and suboptimal self-management in difficult-to-treat RA patients, informing the 2020 EULAR recommendations for the management of difficult-to-treat RA. Methods: A systematic literature review (SLR) was performed: PubMed, Embase and Cochrane databases were searched up to December 2018. Relevant papers were selected and appraised. Effect sizes were extracted or calculated. Results: Three studies were selected on the identification and four on the optimisation of a mismatch in goal setting (Figure 1). No accurate measures were found to identify a mismatch in goal setting, but patients expressed a desire to take their quality of life goals more explicitly into account. Education was found to improve goal setting (4 of 4 studies, effect size not calculable). Five studies were selected on the identification and 31 on the optimisation of suboptimal self-management (Figure 1). Although formal evaluations in high quality studies were lacking, the Arthritis Self-Efficacy Score was found to be the most reliable tool to identify suboptimal self-management. Patients were found to desire more education on nutrition, the disease and the diagnostic process to be able to improve self-management. Self-management programs, educational and psychological interventions were found to improve self-management (Table 1). Table 1: Effect sizes of studies on the optimisation of self-management Outcome Type of intervention Benefit of intervention compared to control 1 in n of n selected studies Studies with effect size ( n ) Effect size per study 2 Self-efficacy Self-management programs 12/13 6 0.18−0.39; 0.23−0.67; 0.37; 0.43−0.53; 0.49; 3 7.52−8.25 Education 6/6 3 0.05−0.17; 0.22−0.59; 1.23 Psychological 2/2 2 0.20−0.35; 0.45 Anxiety Psychological 1/2 1 0.17 3 Depressive symptoms Psychological 1/2 1 0.15−0.33 3 RA knowledge Education 3/3 2 0.34−0.47; 0.84 n: number of studies; RA: rheumatoid arthritis. 1. Mostly usual care or wait list; 2. If different outcome measures were used the range in effect sizes over these measures is reported; 3. Pooled effect size, reported in systematic literature review. Conclusion: In difficult-to-treat RA patients, limited evidence was found on a mismatch in goal setting and suboptimal self-management, especially regarding their identification. Non-pharmacological interventions were found to improve goal setting and self-management. References: [1]Smolen JS et al. Ann Rheum Dis 2020. Epub ahead of print. Disclosure of Interests: Nadia M. T. Roodenrijs: None declared, Attila Hamar: None declared, Melinda Kedves: None declared, György Nagy: None declared, Jacob M. van Laar Grant/research support from: MSD, Genentech, Consultant of: MSD, Roche, Pfizer, Eli Lilly, BMS, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Paco Welsing: None declared