AB1268 No differences between hospital and clinic in patients with rheumatoid arthritis based on real-world data from the aora observational cohort study in japan
Authors: T. Kashiwagura, M. Kobayashi, M. Urayama, N. Konishi, T. Aizawa, H. Itoh, Y. Sugimura, H. Aonuma, T. Kawano, T. Sakuraba, N. Miyakoshi, Y. Shimada
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> In Japan, orthopaedic surgeons, rather than internists, are often involved in the management of rheumatoid arthritis (RA), including drug treatment. However, the paradigm shift in the RA management has changed, and orthopaedic surgeons have often faced challenges in treating RA. The proportion of RA patients treated by orthopaedic surgeons is high in Akita Prefecture, located in Tohoku region in Japan. Akita Prefecture has the 6th largest area in Japan and the highest ageing rate. As many elderly patients have difficulty commuting to distant clinics or hospitals, specialised centres are desirable for advanced treatment of RA. However, in Akita Prefecture, the focus has been on improving treatment of RA by orthopaedic surgeons in the community. In 2010, the Akita Orthopaedic Group on RA (AORA) was established. Currently, 18 hospitals and 10 clinics are participating in the group, and cover all medical districts throughout the prefecture. In addition to a regular study meeting, a workshop on joint ultrasonography and a case conference with internists have been held. We established a case registration system (AORA registry) 8 years ago. This system has enabled us to share treatment experiences. <h3>Objectives</h3> This study examined whether the AORA clinics have provided consistent community-based care comparable to that provided by hospitals. <h3>Methods</h3> Data from the 2017 AORA registry (including 2238 registrations [1300 in hospitals and 938 in clinics]) were used. <h3>Results</h3> Patients treated in clinics were younger (68.1 years in hospitals vs. 64.4.1 years in clinics), and had shorter duration of disease (157.4.0±4.0 months in hospitals vs. 143.5±4.5 months in clinics). The frequency and amount of methotrexate use were not significantly different between the two groups, while those of prednisolone use were greater in patients treated in hospitals than in those treated in clinics. There were no significant differences in the frequency or amount of biological disease-modifying antirheumatic drug use (19.9% in hospitals vs. 18.9% in clinics). There were also no significant differences in disease activity (Disease Activity Score-28-erythrocyte sedimentation rate) in the total cohort (2.91±0.04 in hospitals vs. 2.90±0.04 in clinics) or in patients aged 80 years or older (n=341) (3.35±0.08 in hospitals vs. 3.37±0.11 in clinics). The frequency and amount of drug use for treatment of osteoporosis were significantly higher in patients treated in hospitals than in those treated in clinics. <h3>Conclusions</h3> The results of this study showed that RA treatment outcomes were not significantly different between hospitals and clinics, indicating that the treatment level provided at orthopaedic clinics in the community was high and in accordance with the treat-to-target strategy. Given that orthopaedic surgeons are better able to examine joints and are able to treat osteoporosis, they are expected to treat more RA patients. We believe that the AORA plays an important role in maintaining the quality of clinical services for RA patients in Akita Prefecture. <h3>Disclosure of Interest</h3> None declared