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AB1183 Joint Operations as an Indicator of Disease Severity and Burden in the Quest-RA Study
  1. T. Sokka1,
  2. N. Khan2,
  3. E. Nikiphorou3,
  4. S. Verstappen4,
  5. M. Hetland5,
  6. N. Inanc6,
  7. I. Laurindo7,
  8. S. Stropuviene8,9,
  9. B. Combe10,
  10. M. Cutolo11,
  11. J. Jacobs12
  12. on behalf of QUEST-RA investigators
  1. 1Jyväskylä Central Hospital, Jyvaskyla, Finland
  2. 2University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  3. 3Cambridge University Hospitals NHS Trust, Cambridge
  4. 4University of Manchester, Manchester, United Kingdom
  5. 5Copenhagen University Hospital at Glostrup, Glostrup, Denmark
  6. 6Marmara University, Istanbul, Turkey
  7. 7São Paulo University, São Paulo, Brazil
  8. 8State Research Institute Center for Innovative medicine
  9. 9Vilnius University Medical Faculty, Vilnius, Lithuania
  10. 10Hôpital Lapeyronie, Montpellier, France
  11. 11University of Genova, Genova, Italy
  12. 12University Medical Center Utrecht, Utrecht, Netherlands


Background Joint replacement surgery represents a remarkable mile stone in the care of patients with rheumatoid arthritis (RA), aimed at improving patients' functional capacity and reducing pain. Prior to current therapeutic strategies, surgical joint intervention was a frequent event. Currently, orthopedic surgery is considered as a surrogate marker of failed medical treatment and joint destruction.

Objectives To compare disease burden in RA patients with and without major joint operation (MJO) in the QUEST-RA study.

Methods Consecutive unselected patients with RA receiving usual rheumatology care were included in QUEST-RA study between 2005 and 2012 in 107 clinics in 34 countries (16 with low and 18 with high Gross Domestic Product, GDP, cut at 20,000$/person at the year of enrollment). The review included history of MJO: total joint replacement or fusion of hips, knees, shoulders, elbows, ankles, wrists, and the atlantoaxial joint. Clinical data at the cross sectional visit included disease activity based on DAS28(ESR, 3 variables) and patient reported outcomes (PROs) for disease burden (pain, global health, fatigue on 0-10cm VAS and HAQ on 0-3). Mean values of these variables were compared using parametric statistics in patients with or without history of MJO, according to disease duration (5-10 vs. >10 years), adjusted for age and sex, in countries with low vs. high GDP.

Results QUEST-RA includes 10,142 patients; joint operation data were available in 9069 patients (81%Female, mean age 55, median disease duration from symptom-onset 12 years, 74% RF+). Proportion of RA patients with a history of MJO was more than two times in high GDP countries [12.9% (663/5158)] compared to low GDP countries [5.8% (227/3911)] despite the latter having higher disease activity and worse PROs. Disease burden was higher in patients with a history of MJO across the groups (Table) except in patients with shorter disease duration 5-10 years in low GDP countries (all comparisons p=ns, data not shown).

Table 1.

Mean disease activity and disease burden in patients with RA >5 years, with or without a history of MJO, in countries with low and high GDP

Conclusions In the real world setting in 2005-2012, history of MJO in patients with RA indicated higher disease burden and severity compared to patients without MJO.

Disclosure of Interest None declared

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