SAT0079 PREDICTING PATIENTS WITH HIGH PAIN &amp; PSYCHOLOGICAL SYMPTOMS (P&amp;PS) IN EARLY RHEUMATOID ARTHRITIS USING LATENT CLASS ANALYSIS. RESULTS FROM THE TACERA, A LONGITUDINAL COHORT
Authors: Lewis Carpenter, Katie Bechman, Andrew Cope, Elena Nikiphorou, James Galloway, Sam Norton
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Despite advances in the treatment of rheumatoid arthritis (RA), pain and psychological symptoms remain a burden for many patients. The precise relationship between inflammation and patient reported symptoms, such as pain, fatigue and mental health in the disease is unclear. However, evidence suggests that over time there may be discordance between inflammation and patient reported outcomes, such that some patients with low inflammation will experience persistent symptoms. It is hypothesised that three distinct patient sub-groups exist; low inflammation/low symptoms, low inflammation/high symptoms, and high inflammation/high symptoms. <h3>Objectives:</h3> To identify sub-groups of patients with respect to inflammatory markers and levels of P&amp;PS over time. <h3>Methods:</h3> Demographic, clinical and laboratory data were recorded at baseline (pre-treatment), 6, 12, and 18-months from 239 early RA patients recruited to the Towards A Cure for Early Rheumatoid Arthritis (TACERA) cohort. Individual components of the DAS28 (tender joints, swollen joints, ESR, CRP and patient global) at post-treatment assessments, along with patient reported visual analogue scales for pain, fatigue and the SF-36 Mental Component Score (MCS) were used to identify sub-groups using longitudinal latent class analysis (LCA). Logistic regression models identified variables associated with class membership at 6, 12 and 18-months follow-up. <h3>Results:</h3> LCA indicated two rather than the hypothesised three sub-groups; low inflammation/low symptoms and low inflammation/high symptoms. This was likely because ESR and CRP were well controlled by 6-months and maintained by 18-months for the majority of individuals. There were 86 (36%) 59 (35%) and 41 (39%) classified as having high symptoms at 6, 12 and 18-months. 78% of patients initially in the low symptom group remained in the low symptom group between 6 and 18-months. Rheumatoid Factor (RF) positivity and higher baseline fatigue were associated with high symptoms at 6months; decreasing ESR from 6 to 12-months was associated high symptoms at 12months, and having high symptoms at 12-months, along with reduced Swollen Joint Count (SJC), CRP and MCS from month 12 to 18 was associated with high symptoms at 18-months. <h3>Conclusion:</h3> Tight treatment control resulted in controlled Inflammation by 6-months, resulting in just two main patient sub-groups; those with low and high P&amp;PS. Over one-third of patients experienced high pain and psychological symptoms. Membership of the high symptom group was associated with RF positivity but was mainly driven by prior symptom experience. Whilst inflammatory control remains a primary target, other treatments targeting pain, fatigue and mental health must be considered to reduce the burden of disease. <h3>Disclosure of Interests:</h3> Lewis Carpenter: None declared, Katie Bechman: None declared, Andrew Cope: None declared, Elena Nikiphorou: None declared, James Galloway Consultant for: Pfizer Inc, Sam Norton: None declared