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THU0139 Impacts of Immediate Changes in Dmards on Outcomes in Rheumatoid Arthritis with Moderate-to-Severe Activity
  1. D. Kim1,
  2. C.-B. Choi1,
  3. Y.-K. Sung1,
  4. S.-K. Cho1,
  5. S.-Y. Park1,
  6. J.-Y. Choi1,
  7. D.-H. Yoo1,
  8. S.-S. Lee2,
  9. J. Lee3,
  10. J. Kim4,
  11. H.-S. Lee5,
  12. T.-H. Kim1,
  13. B. Y. Yoon6,
  14. W.-H. Yoo7,
  15. J.-Y. Choe8,
  16. S.-H. Lee9,
  17. S.-C. Shim10,
  18. W. T. Chung11,
  19. S.-J. Hong12,
  20. C. K. Lee13,
  21. E. Koh14,
  22. J.-B. Jun1,
  23. S.-Y. Bang5,
  24. S.-K. Kim8,
  25. H.-S. Cha14,
  26. J. Lee15,
  27. S.-C. Bae1
  1. 1Hanyang University Hospital for Rheumatic Diseases, Seoul
  2. 2Chonnam National University Hospital, Gwangju
  3. 3Ewha Womans University Hospital, Seoul
  4. 4Jeju National University Hospital, Jeju
  5. 5Hanyang University Guri Hospital, Guri
  6. 6Inje University Ilsan Paik Hospital, Goyang
  7. 7Chonbuk National University Hospital, Jeonju
  8. 8Catholic University of Daegu School of Medicine, Daegu
  9. 9Konkuk University Medical Center, Seoul
  10. 10Chungnam National University Hospital, Daejeon
  11. 11Dong-A University Hospital, Busan
  12. 12Kyung Hee University Hospital, Seoul
  13. 13Yeungnam University Hospital, Daegu
  14. 14Sungkyunkwan University School of Medicine, Samsung Medical Center
  15. 15Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea, Republic of

Abstract

Background The importance of tight control is supported by solid clinical evidence. While treating RA with the aim of achieving remission or a low disease activity-as determined by disease activity score employing 28 joints count (DAS28) or the simplified and the clinical disease activity index (SDAI, CDAI) -is reasonable and important, this approach is not widely accepted in the clinical situation.

Objectives To identify the effects of tight control of rheumatoid arthritis (RA) on various disease outcomes in a large observational study.

Methods We selected 1900 RA patients with a baseline DAS28-ESR of more than 3.2 and who had 1 year of follow-up data. The patients were divided into two groups: (1) disease-modifying antirheumatic drugs (DMARDs)-changed group (patients who changed the types or amounts of their DMARDs) and (2) DMARDs-unchanged group (patients who maintained their DMARDs). We measured various disease outcomes, including the Health Assessment Questionnaire–Disability Index (HAQ-DI), DAS28-ESR, C-reactive protein (CRP), ESR, and global health assessments by both physicians and patients. The t-test was used to identify the effects of tight control of RA on various disease outcomes.

Results Patients in the DMARDs-changed group were younger, had a shorter disease duration, used less leflunomide, used more biologic agents. At baseline, they had higher DAS28-ESR (4.62±0.96 in DMARDs-changed group versus 4.42±0.90 in DMARDs-unchanged group, p<0.001), CRP (1.15±1.62 versus 0.81±1.14, p<0.001), global health assessment by both physician (34.05±20.00 versus 26.94±18.16, p<0.001) and patient (48.96±25.34 versus 46.18±24.74, p=0.016). In the comparison between baseline and the 1-year follow-up, the DMARDs-changed group showed greater improvements in HAQ-DI (–0.76±1.43 versus –0.59±1.22, p=0.006), CRP (–0.39±1.71 versus –0.11±1.37 mg/dl, p=0.001), and the global health assessment by a physician (–11.21±24.18 versus –8.10±19.20, p=0.002).

Conclusions Immediate changes in DMARDs according to disease activity can improve disease outcomes, especially DAS28-ESR, CRP, and the global health assessment by a physician.

Disclosure of Interest None Declared

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