Background In recently, with development of biologic agents, RA patients increased the change of reaching remission. But some patients with normalization of inflammatory sign didn't reach to clinical remission state after optimization of treatment.
Objectives This study was performed to investigate the contribution of the more subjective versus the objective component of the DAS28 to response to treatment in RA patient. The secondary aim was to examine the factors associated with 6 month change in pain and EULAR response.
Methods The DAS28-P was calculated (Subjective components of DAS28 relative to the total DAS28: DAS28-P=0.56*sqrt(TJC28) + 0.014*(VAS-GH)/0.56*sqrt(TJC28) + 0.28*sqrt(SJC28) + 0.78 In(ESR) + 0.014*(VAS-GH)). From September 2011 to 2013, 462 new patients were included in this study. EULAR response was assessed after 6month of treatment.
Results The mean age of the included patient was 54 years, and 79% were female. The mean DAS28 at baseline was 4.91±1.07 (range 3.21–8.56) and that at after 6 months of treatment was 3.29±1.28 (range 0.49–8.47). Good responders according to the EULAR criteria were 180 (38.9%), moderate responders 150 (32.4%) and none responders 96 (22.5%). The change of DAS28-P score at baseline and 6 month was significant only for good responders (0.43±0.11 versus 0.3±0.25, p<0.001) and for moderate responders (0.45±0.09 versus 0.41±0.15, p=0.003) but not significant for none responders (0.44±0.13 versus 0.44±0.12, p=0.727). Among those were failed have good response, those who had objective measures (ESR, CRP, and swollen joint) normalized were defined as failure due to subjective measure. Subjects with failure due to subjective measure were less likely to be RF positive and had lower DAS28 after 6month but higher DAS28-P after 6 month.Higher baseline DAS28 score was associated with better pain response while DAS28, DAS28-P and baseline characteristics of patients (sex, age, RF) were not related to EULAR response
Conclusions Our study showed that there are distinct RA patients with high DAS28-P, an index derived from subjective measures, who fails to respond adequately to treatment despite normalization of objective measures.
Disclosure of Interest None declared