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SAT0068 The time until performing tight control as a treat-to-target strategy and the tolerability of methotrexate strongly influence the achievement of clinical remission in rheumatoid arthritis
  1. T Hagiwara,
  2. K Kamada,
  3. N Namura
  1. Rheumatology, Takarazuka City Hospital, Takarazuka, Japan

Abstract

Background Clinical remission (CR) is the first targeted outcome of early treatment for rheumatoid arthritis (RA). Therefore, a consensus is needed for achieving CR by using the treat-to-target (T2T) strategy in RA treatment. However, in patients who received long-term insufficient treatment for RA, achievement of CR becomes increasingly difficult, especially if there is delay in the treatment.

Objectives We aimed to examine factors that hinder successful RA treatment. We believe that making primary-care physicians aware of treatment results will increase the remission rate of RA.

Methods We examined 388 patients with RA who were observed between January and October 2016 and who had not received new disease-modifying anti-rheumatic drugs (DMARDs) more than 3 months before the observation day. We investigated their age at RA onset, sex, Steinbrocker radiographic stage and functional class, activity level, rheumatoid factor (RF), the anti-cyclic citrullinated peptide antibody and DMARDs prescribed at the first consultation (Prescribed Before), disease activity, status of methotrexate (MTX), glucocorticoids (GCs), and biologic agent use at the last observational day.

First, we analysed the assumed remissions by using the Boolean-based definition (Boolean remission) as a purpose variable for these factors. Furthermore, we examined the odds ratio (OR) and 95% confidence interval (95% CI) by using a multiple logistic regression analysis for the statistically significantly different factors.

As for the time-related factor, we recognized that each factor had distinct multiplex collinear characteristics. Therefore, we adopted the time required for the first consultation as disease duration with the most effective values as the analysis object. The representative factor for the functional assessment adopted class according to the number of effective analyses.

Results We recognised the statistically significant differences in disease duration, stage, class at the time of the first medical examination, RF, Prescribed Before, and state of MTX and GCs use at the last observation day for the achievement of Boolean remission.

We examined the multiple logistic regression analysis with the previously mentioned results and obtained the following results.

  • Disease duration (per 1 year); OR 1.110, 95% CI 1.048–1.175, p<0.001.

  • MTX (state; using vs no using); OR 2.522, 95% CI 1.560–4.076, p<0.001.

  • Class at 1st interview; OR 1.512, 95% CI 1.126–2.029, p<0.01.

  • GCs (state; no using vs using); OR 1.803, 95% CI 0.912–3.565, p=0.090.

  • Disease duration (≤1.605y vs >1.605y); OR 2.233, 95% CI 1.437–3.470, p<0.001.

  • MTX (state; using vs no using); OR 2.656, 95% CI 1.644–4.291, p<0.001.

  • Class at 1st interview; OR 1.589, 95% CI 1.181–2.136, p<0.01.

  • GCs (state; no using vs using); OR 1.883, 95% CI 0.956–3.711, p=0.067.

Conclusions Our results indicated the importance of the time required for consultation facilities with the T2T strategy treatment, tolerability for MTX use, and mild dysfunction at the first interview.

The window of opportunity to achieve remission for patients with RA has less time than expected. Therefore, we recommend that physicians should introduce patients with RA to a rheumatologist following the T2T strategy promptly when the primary care provided by the family physician is insufficient.

Disclosure of Interest None declared

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