AB1200 EARLY ARTHRITIS CLINICS IMPROVES THE EVOLUTION OF THE DISEASE AND DECREASES WORK ABSENTEEISM
Authors: M. A. Teran Tinedo, J. Bachiller-Corral
Journal: Annals of the Rheumatic Diseases (2020)

Background: Rheumatoid arthritis is the most common inflammatory arthritis, and a significant cause of morbidity and mortality. Several clinical studies have shown that treatment introduced at an early stage, referred to as a “window of opportunity”, is associated with long-term benefits in the form of long-term remission and even complete remission of the disease. Objectives: Assess the advantages of a Early Arthritis clinic (EAC) in the management of RA until remission is reached and its impact on work absenteeism. Methods: We included a cohort of patients with early RA (≤12 months symptoms) who fullfield the ACR 2010 criteria, in an early arthritis clinic (EAC) from a tertiary hospital, between 2016-2019, followed for at least 2 years. Demographic, clinical, analytical and radiographic variables were included, and the dates of the visits during the follow-up were noted. Work absenteeism days was recorded before and after the first visit. Estadistic description and regressión analysis was performed. Results: Eighty-four patients with early RA were included, with loss of follow-up of tweelve patients. Fifty-one (70,8%) were women with a mean age 50 years ±15,84. Fifty-one patients were FR positive (70,8%) and sixty-eigth were ACPA positive (94,4%). Nine subjects (13%) had erosions. Acute phase reactans elevation was observed in fifty-five patients (76,3%). Thirty-seven subjects (51,3%) were smokers. Mean swollen joint count was 4 ± 4,79 and mean DAS28 was 4.01 ± 1.28. Inflammatory arthralgia was reported since mean time 6.7 months before the first visit. Seventy patients (97%) were treated with methotrexate and forty-nine (70%) did not require other treatment during follow-up. Ten patients (14.3%) required DMARDb, and half received 2 or more drugs of this clase. The mean cumulative time of exposure to corticosteroids was 8.37 ±9,26 months. Mean time between the date of derivation to Rheumatologist and the first visit was 44 days. Forty-nine patients (81%) achieved remission during follow-up and mean time required for this goal was 299 days with a mean 4.7 visits. We found a significant correlation between the time to reach remission with DAS28, NAT and N° treatments prescribed (0.38, 0.39 and 0.70 respectively, p &lt;0.05). Twenty work absenteeism periods (mean 40.55 days) were reported in fourteen patients before the first visit associated with activity of RA, and tweelve periods (mean 19,75 days) in ten patients after the first visit (p &lt;0.05). Conclusion: In our EAC, patients with RA usually reach remission in less than a year, requiring approximately 4 visits to achieve this goal. A significant correlation was found between the time to reach remission, DAS28 and the number of treatments required. Most patients respond to Methotrexate and suspend corticosteroids in less than a year. We found a significant reduction of work absenteeism associated with RA activity, after the first visit during the follow-up. References: [1]Kolarz K. Early reumatoid arthritis. Wiad Lek. 2018;71(5):1061-1065. [2]Nisar MK. Early arthritis clinic is effective for rheumatoid and psoriatic arthritides. Rheumatol Int. 2019 Apr;39(4):657-662. Disclosure of Interests: None declared