AB0762 PREVALENCE AND ASSOCIATED FACTORS OF MEDICAL INERTIA IN THE MANAGEMENT OF RHEUMATOID ARTHRITIS IN DAILY PRACTICE
Authors: M. Kamoun, S. Miladi, A. Fazaa, H. Boussaa, Y. Makhlouf, K. Ouenniche, S. Leila, S. Kassab, S. Chekili, K. Ben Abdelghani, A. Laatar
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic disease. In practice, we observe a difficulty in following recommendations in the management of RA. Non-application of universally known and approved recommendations defines the "medical inertia (MI)". <h3>Objectives:</h3> The aim of our study was to assess the frequency of MI in the therapeutic management of RA in a rheumatology department, to identify the main determinants and to verify the persistence of MI behaviour over time. <h3>Methods:</h3> We conducted an analytical, longitudinal, monocentric study in the rheumatology department in the university hospital Mongi Slim, La Marsa over a period from August 2022 to August 2023. Patients' sociodemographic data, RA characteristics (duration of RA evolution, disease activity (DAS 28), poor prognostic factors), therapeutic data and RA phases were recorded. All patients underwent a clinico-biological assessment of RA activity on the day of inclusion. At the end of each consultation, the reports were studied. MI was investigated using a questionnaire prepared based on the 2018 recommendations of the French rheumatology society (SFR) in the therapeutic management of RA. Secondly, a face-to-face questionnaire was conducted with the attending physician to explain the reasons for the MI. The records of patients identified with MI were re-evaluated at 3 and 6 months from the initial consultation to assess the evolving behaviour of the MI. A univariate analytical study was carried out to identify factors associated with MI. In all statistical tests, the p significance level was set at 0.05. <h3>Results:</h3> We included 90 patients with RA. Analysis of the 90 consultations revealed that MI was present in 65% (n=59). In 42% of cases, non-compliance corresponded to the maintenance of corticosteroid therapy for more than 6 months. The average duration of corticosteroid therapy was 8.5 years ±8. The mean daily dose was 6 mg/day Prednisone equivalent. Lack of intensification of background treatment was the second most common cause of MI, found in 23% of cases. In univariate analysis, the factors statistically significantly associated with the presence of MI were: Female gender (p=0.004), rural location (p=0.018), long-standing RA (p= 0.033), moderately to highly active RA (p=0.001), presence of poor prognostic factors(p=0.026), high physician seniority (p=0.008). The main determinants of MI due to lack of therapeutic intensification were mostly physician-related in 32 cases, patient-related in 20 cases and care systems-related in only 5 cases. MI was not constant over time: at 3 months, it was present in 39% of consultations with initial MI, but only in 17% at 6 months. <h3>Conclusion:</h3> Our study suggests the importance of assessing the applicability of current recommendations in the management of RA at each consultation, and of understanding the different factors of MI. In addition, it is necessary to propose a questionnaire for patients to assess MI and its determinants from their perspective. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>