THU0109 INCREASED MODIFIED HEALTH ASSESSMENT QUESTIONNAIRE (MHAQ) SCORE IS INDEPENDENTLY ASSOCIATED WITH HIGH RISK OF SEVERE INFECTION IN RHEUMATOID ARTHRITIS (RA) PATIENTS
Authors: Yuji Yoshida, Shiro Ohshima, Eri Oguro, Kentaro Kuzuya, Yasutaka Okita, Hidetoshi Matsuoka, Satoru Teshigawara, Maiko Yoshimura, Kentaro Isoda, Yoshinori Harada, Jun Hashimoto, Yukihiko Saeki
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Severe infections that complicate rheumatoid arthritis may cause significant morbidity and mortality. The Modified Health Assessment Questionnaire (MHAQ) is one of the scores most used for measuring the functional status of rheumatoid arthritis (RA) patients. However, the relationship between the MHAQ score and severe infection risk has not been well studied [1]. <h3>Objectives</h3> To examine the relationship between disease-associated functional status (MHAQ) and severe infection events (SIE) in rheumatoid arthritis patients. <h3>Methods</h3> We used data from the "MiRAi" cohort in Japan. In total, 2174 RA outpatients were examined at the Osaka Minami Medical Center between January 2012 and October 2017. The risk factors were identified and evaluated by multivariate logistic regression, linearity analysis. Interactions of SIE risk between MHAQ and treatment were also observed. <h3>Results</h3> The cohort contributed to 8206 patient-years of follow-up. Overall, 251 SIEs were observed and the incidence of SIE was 3.0 infections per 100 patient-years. The mean age at first observation was 61.7 years and the mean disease duration was 10.3 years. The use of glucocorticoids (GCs), methotrexate (MTX), and biologic and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs/tsDMARDs) was 59.2%, 63.8%, and 40.3%, respectively. The mean Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), Disease Activity Scores of 28 joints (DAS28), and MHAQ at first observation were 9.76±6.39, 10.1±6.87, 2.67±0.96, and 0.43±0.58, respectively. Disease duration, the MHAQ score, and prednisolone dose (<i>p</i>=0.015, 0.007, and &lt;0.001, respectively) were significantly associated with SIE risk (Figure). Age, sex, stage, bDMARDs/tsDMARDs use, DAS28-CRP, and MTX dose (mg/week) did not predict a significant increase in SIE. The risk of SIE increased linearly with the MHAQ. The SIE risk increased rapidly from 0 to 5 mg of prednisolone, and then increased gradually over 5 mg. The SIE risk peaked at around 20 years disease duration. No significant interaction between MHAQ and bDMARDs/tsDMARDs or glucocorticoid use were observed (p=0.307, 0.282, respectively). <h3>Conclusion</h3> An increased MHAQ score was lineally associated with SIE, and did not show significant interactions with bDMARD/tsDMARD use or the oral glucocorticoid dose. Therefore, the MHAQ score is considered to be a strong, independent risk factor for infection in RA patients. <h3>Reference</h3> [1] Yamanaka H, Askling J, Berglind N, Franzen S, Frisell T, Garwood C, Greenberg JD, Ho M, Holmqvist M, Novelli Horne L, et al: Infection rates in patients from five rheumatoid arthritis (R017, 3(2):e000498A) registries: contextualising an RA clinical trial programme. RMD Open 2017, 3(2):e000498. <h3>Disclosure of Interests</h3> Yuji Yoshida: None declared, Shiro Ohshima Grant/research support from: AbbVie, Eisai, Asahikasei, Speakers bureau: AbbVie, Eisai, Bristol-Meyers, Novartis, Astellas, Nippon-Kayaku, Pfizer, UCB, Ayumi, Daiichi-Sankyo, Takeda, Tanabe-Matsubishi, Chugai, Eri Oguro: None declared, Kentaro Kuzuya: None declared, Yasutaka Okita: None declared, Hidetoshi Matsuoka: None declared, Satoru Teshigawara: None declared, Maiko Yoshimura: None declared, Kentaro Isoda: None declared, Yoshinori Harada: None declared, Jun Hashimoto: None declared, Yukihiko Saeki: None declared