OP0263-HPR MAJOR STRESSORS IN THE YEAR PRIOR TO RA DIAGNOSIS: IMPACT ON PATIENT-REPORTED OUTCOMES ONE YEAR LATER
Authors: N. Andersen, O. Schieir, M. F. Valois, G. Boire, J. Pope, G. Hazlewood, L. Bessette, C. Hitchon, D. Tin, C. Thorne, E. Keystone, V. Bykerk, S. J. Bartlett
Journal: Annals of the Rheumatic Diseases (2020)

Background: Stress is implicated in RA onset and poorer prognoses through changes in neuro-endocrine and autoimmune function. Although many people with RA link disease onset to recent stressful life events, results from retrospective studies are unclear. Objectives: To describe the incidence of major stressors (+STRESS ) in year prior to diagnosis and compare characteristics and patient-reported outcomes (PROs) of newly diagnosed RA patients with and without +STRESS at 0 and 12 months. Methods: Data were from early RA patients (symptoms &lt;1 yr) enrolled in the Canadian Early Arthritis Cohort (CATCH) from 2007-17 who met 1987/2010 ACR/EULAR criteria and had ≥12 months of follow-up. Patients reported major psychological (death, divorce/separation, family, financial, other) and physical (motor vehicle accident, surgery, major illness/infection, other) stressors in previous year. We used independent t-tests and chi square to compare characteristics by stressors at baseline, and multivariable regression to examine the impact of +STRESS on disease activity and PROs at 1 year, adjusting for age, sex, education, fibromyalgia, and SJC. Results: The 1933 adults were mostly female (72%), with a mean (SD) age of 55 (15) years. 52% reported 1+ stressors in previous year; family (48%), financial stress (36%), death (35%), surgery (28%), and major illness (26%) were the most common stressors. Patients with +STRESS were more likely to be women, younger, have more comorbidities including fibromyalgia, and higher mean DAS28. Patients with +STRESS also had significantly higher mean pain, fatigue, depression, sleep disturbance, patient global, and HAQ scores at baseline. At 1 year, SJC and the proportion in DAS28 REM was similar between groups. However, PROs (pain, HAQ, Fatigue, Pt Global, Depression, Poor Sleep) remained higher in +STRESS , with evidence of an additive effect for number of stressors and having both physical and psychological stressors (Table). The greatest impacts were on mood, sleep disturbance, and fatigue. Conclusion: In this pan-Canadian early RA cohort, more than half reported 1+ stressful life events in the year prior to diagnosis. Individuals reporting major stressors had significantly worse pain, patient global, disability, depression, fatigue, and sleep disturbance at diagnosis; 1 year later, though disease activity was similar between groups, the effects of +STRESS on PROs persisted. Early RA patients with recent major stressors may benefit from emotional support and stress reduction to optimize how they feel and function. Mean (SD) or N (%) No Stress (N=928; 48%) Physical (N=131; 7%) Psychological (N=658; 34%) Both (N=216; 11%) Age 56 (15) 56 (15) 53 (14) 52 (15) Women 622 (67%) 82 (63%) 512 (78%) 174 (81%) College Education 464 (50%) 76 (58%) 345 (52%) 126 (58%) Rheum Dis Comorbid Index 1.1 (1.2) 1.4 (1.4) 1.1 (1.3) 1.4 (1.3) OA or Spinal pain 168 (18%) 35 (27%) 117 (18%) 55 (25%) Fibromyalgia diagnosis 15 (2%) 2 (2%) 13 (2%) 11 (5%) Symptom duration (months) 5.6 (3.0) 5.7 (3.0) 5.9 (3.0) 5.9 (3.0) DAS28 – mean 5.0 (1.4) 5.1 (1.5) 5.0 (1.5) 5.2 (1.4) MTX ±csDMARDs 679 (73%) 100 (76%) 489 (74%) 166 (77%) Oral Steroids 295 (32%) 40 (31%) 215 (33%) 55 (25%) Pain (0-10) 5.3 (2.8) 5.5 (2.9) 5.7 (2.8) 6.2 (2.8) HAQ-DI 1.0 (0.7) 1.2 (0.7) 1.1 (0.7) 1.3 (0.7) Fatigue (0-10) 4.7 (3.1) 5.0 (3.0) 5.7 (2.9) 5.9 (2.9) Patient Global (0-10) 5.6 (2.9) 6.0 (2.9) 6.0 (2.9) 6.4 (3.0) Depression (SF12 MCS &lt; 45.6) 329 (35%) 54 (41%) 356 (54%) 123 (57%) Poor sleep (0-10) 4.5 (3.4) 4.8 (3.3) 5.3 (3.2) 6.0 (3.1) Disclosure of Interests: Nicole Andersen: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance) Amgen Canada (CATCH, clinical nurse) Abbvie (CATCH, clinical nurse) Pfizer (CATCH, Registry of biologics, Clinical nurse) Hoffman-LaRoche (CATCH) UCB Canada (CATCH, Clinical nurse) BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT) Janssen (CATCH) Celgene (Clinical nurse) Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly &amp; Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly &amp; Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Glen Hazlewood: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer Speakers bureau: Medexus/Medac, 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 of: 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, Vivian Bykerk: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie