POS0333 DETERMINANTS OF RESIDUAL PAIN IN PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES IN REMISSION: A LATENT CLASS ANALYSIS FROM THE COVAD GLOBAL SURVEY
Authors: I. Hmamouchi, N. Ziade, B. Salameh, M. Moussallem, E. Kadam, A. L. Tan, J. Knitza, D. Dzifa, S. Saha, O. Distler, A. E. Gracia-Ramos, R. Aggarwal, V. Agarwal, L. Gupta
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Pain plays an essential role in therapeutic decision-making in autoimmune rheumatic diseases (AIRDs). However, it may persist in patients in disease remission, thus impacting quality of life and leading to unnecessary escalation of therapy. <h3>Objectives:</h3> Using the COVAD2 global database, we aimed to explore the self-reported pain landscape across AIRDs, with a particular focus on patients in disease remission. In addition, we identified the core drivers of pain among patients in remission in regard to socio-demographic characteristics, comorbidities, and patient-reported outcomes (PROs) using validated scales. <h3>Methods:</h3> The study was an ancillary analysis from the COVAD2 international cross-sectional, multi-centre patient self-reported online study conducted by 157 investigators from 110 countries, collecting PROs in patients with AIDs and healthy controls (HC). Pain was assessed via the 11-point NRS and then transformed into a binary variable using the median as a cutoff. Patients were considered in remission if they self-reported inactive disease or remission and were treated with glucocorticoids daily dose &lt;10 mg/day. The PRO Measurement Information System (PROMIS) score was recorded with global physical health (GPH), mental health (GMH), function and fatigue 4a. We performed latent class analysis (LCA) to reveal hidden profiles of AIRD patients in remission with pain and assessed the association of individual characteristics (namely age, gender, continent and/or ethnicity, disease duration, AIRDs, fatigue, PROMIS GPH, GMH) with membership of latent subclasses using logistic regression. <h3>Results:</h3> Of 10,739 participants, 6,390 had AIRDs, 572 had non-rheumatic (nr-)AIDs, and 3,777 were HC. Most participants were from Asia, North America and Europe (26% from each), median age 45 years (IQR 35-58), 7,930 (74%) females, median AIRD disease duration 8 years (IQR 3-15), 823 patients (20%) were in disease remission. Among all participants, the mean level of pain was 2.8 (SD 2.6), significantly higher in patients with AIRDs, 3.6 (SD 2.15), compared to nr-AIDs, 2.4 (SD 2.5) and HC, 1.5 (SD 2.5) (p&lt;0.001). In patients with AIRDs in remission, pain was significantly lower compared to those with active disease (2.2 (SD 2.3) <i>vs</i> 3.8 (SD 2.5), p&lt;0.001), but remained higher <i>vs</i> nr-AIDs (1.3 (SD 2.0)) and HC (1.1 (SD 1.7)) (p&lt;0.001). In those patients, a higher level of pain was associated with older age, longer disease duration, female gender, higher HDI, continent (highest in Africa, lowest in Asia), and ethnicity (highest in native Americans and lowest in Asians), type of AIRD (highest in RA, lowest in CTDs), higher fatigue, poorer function, psychiatric comorbidity, basic multimorbidity, PGPH, and PGMH. The LCA identified a 2-class basic model as optimal. The first latent class, with a prevalence of 48.5%, had a high probability of high pain (0.94) and of active disease (0.31). The second one had a prevalence of 51.5% with a low probability of high pain (0.09) and of active disease (0.09). The first class was associated with the type of AIRD (RA, OR 1.2 [95% CI 1.10-1.50] compared to CTDs), the continent (Europe, OR 1.22 [95% CI 1.01-1.48]), higher PGPH (OR 1.19 [95% CI 1.01-1.40] after adjusting on age, gender, PROMOS GPH, PROMIS GMH, Fatigue and disease duration. <h3>Conclusion:</h3> Data from the COVAD2 study identified significant residual pain in patients with AIRDs in remission status. Determinants of this residual pain were identified and should be considered on a personalized basis in order to avoid unnecessary anti-rheumatic treatment escalation. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>