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SP0008 A ra with persistant high disease activity under biological treatment: how does changing diagnosis change management and outcome?
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  1. A.P. Trouvin
  1. Pain Evaluation and Treatment Department, Hopital Cochin, Paris, France

Abstract

We shall discuss the clinical case of a 45 years old woman. She has been diagnosed with rheumatoid arthritis, rheumatoid factor and ACPA are positive, acute phase reactants were elevated and no erosion was detected on the initial X-Rays. After a first line treatment with a conventional DMARD during 18 months, she experienced new flares with multiple synovitis and with elevated acute phase reactants. A TNF-inhibitor treatment was initiated. After 3 months, low disease activity was not reached hence biologic treatment was switched to abatacept. After 3 months, the patient still complained of pain in her hands and feet but acute phase reactants normalised, DAS-28 score is 5,20 (TJC: 18 , SJC: 0, ESR 14 mm/h, VAS general health patient: 70/100). Question rose to change biological therapy once again. The case presentation will discuss how a possible fibromyalgia can, in this case, be confounding in the patient’s clinical evaluation and therefore change the management of the patient.

We shall discuss the clinical case of a 45 years old woman. She has been diagnosed with rheumatoid arthritis, rheumatoid factor and ACPA are positive, acute phase reactants were elevated and no erosion was detected on the initial X-Rays. After a first line treatment with a conventional DMARD during 18 months, she experienced new flares with multiple synovitis and with elevated acute phase reactants. A TNF-inhibitor treatment was initiated. After 3 months, low disease activity was not reached hence biologic treatment was switched to abatacept. After 3 months, the patient still complained of pain in her hands and feet but acute phase reactants normalised, DAS-28 score is 5,20 (TJC: 18 , SJC: 0, ESR 14 mm/h, VAS general health patient: 70/100). Question rose to change biological therapy once again. The case presentation will discuss how a possible fibromyalgia can, in this case, be confounding in the patient’s clinical evaluation and therefore change the management of the patient.

Disclosure of Interest None declared

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