AB0232 TIGHT CONTROL MANAGEMENT OF EARLY RA ACHIEVES MORE PATIENTS IN REMISSION AT 6 MONTHS AND IMPROVES PAIN, FUNCTION AND FATIGUE AT 24 MONTHS COMPARED TO A CONTROL GROUP
Authors: Maria Aronsson, Annika Teleman, Stefan Bergman, Kristina Forslind, Maria Andersson
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Even with modern antirheumatic treatment, many patients experience chronic pain and loss of function despite less disease activity. The understanding of how this chronic pain development can be prevented is sparse. There is furthermore little knowledge if a tight control management without specific treatment schemes and instructions for the physicians to follow could increase the remission frequency. <h3>Objectives</h3> To determine whether solely a tight control management of patients, without further intervention in the physician's work, can increase the remission frequency and improve patient reported outcome in early RA. <h3>Methods</h3> <b>In all, 96 patients with early RA were consecutively included in a tight control study group (TCS).</b> Inclusion criteria were early RA patients (&lt;13 month duration) with no previous history of rheumatic disease. <b>A control group, with so far 27 patients receiving standard care, has been analyzed.</b> The tight control management included monthly visits to the physician the first 6 months, followed by visits at 9, 12 and 24 months. If not in remission at 6 months the patients' monthly visits could continue to 12 months. The study did not include any treatment guidelines for the physicians. Pain, Fatigue and the Patient's Global Assessment of the General Health (<b>PtGA)</b> were reported on a Visual Analogue Scale (VAS). The 28 tender and swollen joint score, DAS28, C-Reactive protein, Erythrocyte sedimentation rate and Health Assessment Questionnaire (HAQ) were assessed. <h3>Results</h3> There was no significant difference between the groups at baseline in gender, age, smoking, disease duration, disease activity, pain, HAQ, fatigue, RF and ACPA. There was a significant difference between groups in outcome, with 70% of TCS and 37% of control patients in remission (DAS28 &lt;2.6), p=0.010, at 6 months, figure 1A. At 12 and 24 months there was no significant difference in the remission frequency, figure 1A. The TCS group improved more than the control group in Pain, Fatigue and HAQ during follow up, figure 1B-D. The median VAS pain at 24 months was 11 (IQR 2-22) in the TCS group and 22 (IQR 6-42) in the control group, p=0.036. The median VAS fatigue was 13 (IQR 2-38) in the TCS group and 33 (IQR 8-70) in the control group p=0.028 at 24 months. The difference in HAQ reached significant numbers solely at 6 months where the median was 0.13 (IQR 0-0.50) in the TCS group and 0.57 in the control group (IQR 0.16-0.94). <h3>Conclusion</h3> Patients in tight control reached remission faster than patients receiving standard care. They also reported less pain and fatigue, despite the fact that there was no difference in remission frequency at 24 months. The results indicate that a tight control scheme could influence pain development in patients with early RA, but further studies are required. <h3>Disclosure of Interests</h3> Maria Aronsson: None declared, Annika Teleman Consultant for: Pfizer expert Group 2016, Sanofi expert Group 2017. No association with this study., Stefan Bergman: None declared, Kristina Forslind: None declared, Maria Andersson: None declared