OP0315 ACHIEVING A LOW DISEASE STATE WITHIN FIRST 3 MONTHS IN EARLY RHEUMATOID ARTHRITIS RESULTS IN LOWER FATIGUE OVER 5 YEARS
Authors: Melissa Holdren, Orit Schieir, Susan J. Bartlett, Louis Bessette, Gilles Boire, Glen Hazlewood, Carol Hitchon, Edward Keystone, Diane Tin, Carter Thorne, Vivian Bykerk, Janet Pope
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Up to 80% of rheumatoid arthritis patients report clinically relevant fatigue.<sup>1</sup> Fatigue is complex multi-factorial process that can result in adverse affects on patients' physical and emotional well-being.<sup>2</sup> <h3>Objectives</h3> To examine the relationship between disease activity and fatigue over time in early rheumatoid arthritis (ERA). <h3>Methods</h3> Data were from patients with ERA (symptoms ≤ 12 months) enrolled in the Canadian Early Arthritis Cohort (CATCH). CATCH participants completed repeat clinical assessments, laboratory investigations and self-reported questionnaires including rating their fatigue over the past week using a 10 point numerical rating scale (NRS). Fatigue severity was classified as low (≤2); moderate (&gt;2 but &lt;5) and high (≥5) based on other published RA studies. Bivariate relationships between disease activity measures and fatigue over 5 years of follow-up were estimated using the Pearson correlation coefficient. T-tests and repeated measures anova were used to compare differences in fatigue ratings in patient who did vs. did not achieve a low disease state (DAS28 &lt;3.2) within 3-months of cohort entry. <h3>Results</h3> Of the 1864 patients included, 1640 (88%) met criteria for RA, 1342 (72%) were women and most had moderate-high baseline disease with a mean (SD) DAS28 of 4.9 (1.5). Fatigue was common with 19% reporting moderate and 59% severe fatigue at baseline. Fatigue was positively and strongly correlated with pain and patient global ratings (r 0.56-0.67, p&lt;0.001), positively and moderately correlated with DAS28 (r 0.35-0.49, p&lt;0.001), and positively but more weakly correlated with tender/swollen joint count, physician global assessment, ESR and CRP (r 0.10-0.39, p&lt;0.01) throughout the first year of follow-up. Patients who reported low fatigue severity by three months continued to have significantly lower fatigue throughout follow-up compared to those with moderate or high fatigue (p&lt;0.001). Patients who achieved DAS28 REM or LDA within 3-months of cohort entry had significantly lower mean fatigue compared to those with more active disease throughout 5 years of follow-up (p&lt;0.001) (Figure 1). DAS28: disease activity score in 28 joints; REM: remission; LDA: low disease activity; MDA: moderate disease activity; HDA: high disease activity. <h3>Conclusion</h3> Fatigue is common in ERA and is most strongly correlated with pain and disease activity. Early treatment response within 3-months was associated with short and long-term improvements in fatigue over time. Further longitudinal research examining the time-varing effects of both clinical and psychosocial factors on fatigue is needed. <h3>References</h3> [1] Pollard, LC., Choy, HE., Gonzalez, J., Khoshaba, B., and Scott, DL. Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology. 2006;45:885-889. [2] Nikolaus, S., Bode, C., Taal, E., and Van De Laar, MA. Fatigue and Factors Relating to Fatigue in Rheumatoid Arthritis: A systematic Review. American College of Rheumatology. 2013;65:1128-1146. <h3>Acknowledgement</h3> On behalf of Canadian Early Arthritis Cohort (CATCH) Investigators <h3>Disclosure of Interests</h3> Melissa Holdren: None declared, Orit Schieir: None declared, Susan J. Bartlett Consultant for: Pfizer, UCB, Lilly, Novartis, Merck, Jansen, Abbvie, Louis Bessette Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Consultant for: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Speakers bureau: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilles Boire Grant/research support from: Investigator-initiated studies: Amgen, Abbvie, BMS, Eli Lilly, Merck, Novartis, Pfizer, Consultant for: Advisory boards: Amgen, BMS, Celgene, Eli Lilly, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood : None declared, CArol Hitchon Grant/research support from: Pfizer, UCB (unrelated studies), Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant for: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Grant/research support from: Investigator-initiated studies: Amgen, Pfizer. RCTs: Abbvie, Celgene, CaREBiodam, Novartis, Pfizer, Consultant for: Advisory board: Abbvie, Amgen, Celgene, Lilly, Medexus/Medac, Merck, Novartis, Pfizer, Sanofi. Consultant: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Vivian Bykerk Grant/research support from: Mallinckrodt, BMS, Crescendo Biosciences, Sanofi/Regeneron., Consultant for: Amgen, Pfizer, UCB, Scipher, Sanofi/Genzyme/Regeneron, Janet Pope Consultant for: Eli Lilly and Company