Laura Margaretha Maria Steunebrink

Determinants of Perceived Health Nonimprovement in Early Rheumatoid Arthritis Patients With Favorable Treatment Outcomes

To explore the association between achieving favorable clinical outcomes and patients’ perceived change in overall health status after 12 months of treat‐to‐target in patients with early rheumatoid arthritis (RA) and to identify determinants of subjective nonimprovement.

Zorguitkomsten gezien vanuit de reumapatiënt

SamenvattingTransparantie van zorg en inzicht in resultaten: het wordt steeds belangrijker in de gezondheidszorg. Meten is weten: het geeft zorgaanbieders inzicht in de eigen behandelresultaten en maakt aspecten van kwaliteit van zorg inzichtelijk. Zo beschrijven Patient Reported Outcome Measures (PROM’s) uitkomsten van zorg vanuit het perspectief van de patiënt. De aandacht voor deze PROM’s is groeiende. Medisch Centrum Twente speelt hier op in met een onderzoek naar PROM’s bij reumapatiënten.

THU0071 Radiographic progression in early rheumatoid arthritis patients following initial combination versus step-up treat to target therapy in daily clinical practice: results from the dream registry

Background Early and aggressive targeted treatment with disease modifying anti-rheumatic drugs (DMARDs) has been shown to lead to substantial reductions in disease activity (1,2) and radiologic damage in patients with early rheumatoid arthritis (RA) (3,4). Objectives The aim of this study was to compare the first-year radiographic progression rates between a treat-to-target (T2T) strategy with initial combination therapy (strategy II) versus an initial step-up monotherapy (strategy I). Methods A total of 128 patients from strategy II was individually matched with 128 patients from strategy I on sex, age (± 5 yrs.) and baseline disease activity (± 0.5 on the DAS28). Differences in radiographic progression scores and the number of patients experiencing a minimal clinically important difference (≥5 SHS points; MCID) between both strategies were tested with Mann Whitney U test and chi-square test. Next, linear and logistic regression analyses were performed to examine which baseline variables were associated with radiographic progression scores and the probability of experiencing an MCID within 1 year. Results Patients with initial combination therapy had slightly higher baseline disease activity scores and pain scores, but better mental health scores. Patients with initial monotherapy had significantly more, and more frequently clinically relevant, radiographic progression after one year. Experiencing a MCID was associated with fewer tender joints (p=0.05) and higher ESR (p=0.02) at baseline. Conclusions Excellent radiographic outcome was achieved for patients treated according to a protocolled T2T strategy in daily clinical practice. Patients treated with initial monotherapy had significantly more short-term radiographic progression than patients treated with initial combination therapy. References Steunebrink LMM, Vonkeman HE, ten Klooster PM, et al. (2016) Recently diagnosed rheumatoid arthritis patients benefit from a treat-to-target strategy: results from the DREAM registry. Clin Rheumatol 35:609–615. doi: 10.1007/s10067–016–3191–3. Steunebrink LMM, Versteeg GA, Vonkeman HE, et al. (2015) Initial combination therapy versus step-up therapy in treatment to the target of remission in daily clinical practice in early rheumatoid arthritis patients: results from the DREAM registry. Arthritis Res Ther 18:60. doi: 10.1186/s13075–016–0962–9. Stenger AA, Van Leeuwen MA, Houtman PM, et al. (1998) Early effective suppression of inflammation in rheumatoid arthritis reduces radiographic progression. Br J Rheumatol 37:1157–63. Goekoop-Ruiterman YPM, de Vries-Bouwstra JK, Allaart CF, et al. (2008) Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): A randomized, controlled trial. Arthritis Rheum 58:S126–35. doi: 10.1002/art.23364. Acknowledgements We would like to thank all the patients, rheumatology nurses, and rheumatologists who participated in our study. Disclosure of Interest None declared

THU0111 Prevalence and Cross-Sectional Associations of Neuropathic-Like Pain Features in Rheumatoid Arthritis

Background Pain control in rheumatoid arthritis (RA) is often inadequate and clinically significant pain persists in a substantial proportion of patients, even when inflammation appears to be well controlled. This suggests that inflammation or subsequent joint damage might not be the only factor causing pain in RA. Accumulating evidence suggests that features of neuropathic pain may also be present in patients with rheumatic pain conditions. Objectives To estimate the prevalence and factors associated with neuropathic-like pain symptoms in patients with rheumatoid arthritis (RA). Methods A cross-sectional sample of 159 RA patients completed the painDETECT questionnaire along with other self-reported measures before their visit to the rheumatology outpatient clinic. Univariate analyses and multivariable logistic regression were used to identify factors associated with neuropathic pain features. Results The large majority of patients (88%) were in remission or had low disease activity, but 44% of the patients continued to report clinically significant pain. According to the painDETECT, 27 patients (17.0%) were classified as having likely neuropathic pain and 34 patients (21.4%) as having possible neuropathic pain. Besides reporting more intense pain, patients with likely or possible neuropathic pain were more likely to meet the diagnostic criteria for fibromyalgia, to use analgesics, and to have more tender joints and worse physical and mental health status as measured by the SF-36. In multivariable analysis, physical (P<0.001) and mental health status (P=0.006) remained significantly associated with neuropathic pain features, even after controlling for pain severity. Conclusions Neuropathic-like pain symptoms are present in a substantial number of patients with RA and are associated with worse physical and mental health. These symptoms may represent central sensitization and underscore the need for further research and screening of pain mechanisms in RA patients. Disclosure of Interest None declared

THU0118 General Applicability of a New Treat-to-Target Treatment Strategy in Dutch Patients with Early Rheumatoid Arthritis: Results from the Dream Remission induction Cohort II

Background New treatment options and strategies have dramatically reduced the severity and impact of rheumatoid arthritis (RA) and especially early intensive combination therapy, aimed at achieving remission, has shown good clinical outcomes. The reason for early identification and treatment of RA is to control progression of the disease. Since there is no cure for RA, the current most important goal is to reach remission as soon as possible, which should be sustained during the course of the disease. Objectives Despite wide implementation of treat-to-target (T2T) strategies in RA, a proportion of patients still fail to achieve early remission. This study aimed to identify baseline predictors of reaching remission in Dutch patients with early RA following a T2T strategy. Methods Baseline demographic, clinical and patient-reported outcome measures and one-year follow-up data were used from patients with early RA included in the DREAM remission induction cohort II study. Survival analyses and simple and multivariable logistic regression analyses were used to examine remission rates and significant predictors of achieving remission. Results A total number of 137 patients was included. 77.2% of the patients reached remission at least once in 12 months follow-up, and median time to first remission was 17 weeks. None of the examined baseline variables were significantly associated with achieving remission within 1 year. Lower ESR (p=0.007), male gender (p=0.057), better physical health status (p=0.062) and fewer tender joints (p=0.175) were significantly or marginally associated with achieving remission within 17 weeks. In multivariable analysis, however, only ESR remained significantly predictive (p=0.023). Conclusions The results indicate that baseline characteristics were not predictive of early remission. Together with the high proportion of responders, this provides additional evidence for the general applicability of T2T strategies in patients with early RA. Disclosure of Interest None declared