THU0103 ONE IN FIVE PATIENTS WITH RAPIDLY AND PERSISTENTLY CONTROLLED EARLY RHEUMATOID ARTHRITIS REPORT POOR WELLBEING AFTER ONE YEAR OF TREATMENT
Authors: Kristien Van der Elst, Patrick Verschueren, Diederik De Cock, An De Groef, Veerle Stouten, Sofia Pazmino, Johanna Vriezekolk, Johan Joly, Philip Moons, Rene Westhovens
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> In rheumatoid arthritis (RA), good disease control without major joint damage, loss of function or disability can be achieved. Still, a substantial number of patients report poor wellbeing. A better understanding is needed on why some patients still feel unwell despite good disease control. Specific attention to this mismatch, especially early in the disease, could help to further optimize the clinical course of new patients with RA. <h3>Objectives</h3> To identify and characterize patients with early RA treated optimally to current standards but reporting not feeling well after 1 year of treatment. <h3>Methods</h3> We included participants of the Care in early RA trial with an early and persistently favorable treatment response, defined as having a disease activity score (DAS28CRP) &lt;2.6 from 16 weeks after initiation of treatment until year 1. Feeling well was assessed with 5 patient-reported outcomes (PROs): pain, fatigue, physical functioning, RA-related quality of life and sleep quality. K-means clustering was carried out to assign patients to clusters based on these PRO scores at year 1. After clustering, Cohen's d was computed to determine the magnitude of the difference between clusters, already at treatment start (BL) and 4 months later (w16), with respect to the 5 clustering PROs as well as for coping behavior, illness perceptions and social support. <h3>Results</h3> Analyses revealed 3 distinct clusters. Details are depicted in Table 1. Of 140 patients, 77.9% were assigned to the 'concordant to disease activity' cluster, 9.3% to the 'dominant fatigue' cluster and 12.9% to the 'dominant pain and fatigue' cluster. When comparing the concordant cluster with both discordant clusters, differences at BL and w16 were shown, with small effects on patients' evaluation of their disease at year 1, such as more negative beliefs about the consequences of RA at w16 in patients reporting dominant pain and fatigue at year 1. Few differences with medium effects were identified, such as a moderately higher use of avoidance as a coping style at w16 and a stronger belief that symptoms can be explained by RA at w16, in patients reporting dominant fatigue at year 1 compared to patients in the concordant cluster. Large differences between patients in concordant and discordant clusters were found for pain and fatigue levels, which were already higher after 4 months of treatment for those patients reporting persistent pain and fatigue at year 1. <h3>Conclusion</h3> Three distinct groups of persistent responders with early RA were identified based on their 1-year PRO profile. The majority of patients were well-synchronized, reporting very low pain and fatigue levels in concordance with their well-controlled disease activity. One in 5 persistent responders, however, seemed to have unmet needs. In view of early identification of patients at risk of poor wellbeing despite good disease control, early pain and fatigue levels and certain coping behavior and illness perceptions were recognized as potential targets for future interventions. <h3>Disclosure of Interests</h3> Kristien Van der Elst: None declared, Patrick Verschueren Grant/research support from: Unrestricted Pfizer Grant for Early RA research, Diederik De Cock: None declared, An De Groef: None declared, Veerle Stouten: None declared, Sofia Pazmino: None declared, Johanna Vriezekolk: None declared, Johan Joly: None declared, Philip Moons: None declared, Rene Westhovens Grant/research support from: Bristol-Myers Squibb, Consultant for: Celltrion, Galapagos-Gilead&nbsp; <h3>DOI: 10.1136/annrheumdis-2019-eular.3629</h3>