BackgroundEarly RA is characterized by multiple symptoms that impact daily function and HRQL. Little is known about whether there are symptom clusters evident at diagnosis that could identify patients with a poorer prognosis, or the stability of clusters over time.ObjectivesTo identify patient-reported symptom clusters at RA diagnosis, associated sociodemographic and RA characteristics, and the stability of clusters over the first 6 months.MethodsUsing data from the Canadian Early Arthritis Cohort (CATCH), we appliedlatent class analysiswith baseline PROMIS-29 pain, fatigue, depression, anxiety, and sleep scores to select relevant symptoms and levels using AIC, BIC, G-square and log-likelihood results. Baseline PRO and clinical differences among clusters were compared. Next, we evaluated the stability of these clusters at 3 and 6 months.Latent transition analysiswas used to estimate the probability of transitioning among classes.ResultsThe sample included 310 adults with a new RA diagnosis, with 6-month PROs available, and who were MTX naïve at baseline. Participants had a mean age 56, CDAI 29.3, and symptoms for 5 months; 67% were women and 78% White. The optimal symptom set included pain, fatigue, depression, and anxiety (levels: none, mild, moderate, severe). We identified 4 clusters:Minimal(12%);Moderate Pain Dominant(40%);Multiple Moderate-Severe(35%); andMultiple Mild(11%). Clusters had similar sociodemographics exceptMinimalwere slightly older and less female; SJC and TJC were similar among classesMultiple MildorModerate-Severeclasses had significantly worse mood and sleep (Table 1). More patients inMultiple Moderate-SevereandModerate Painhad parenteral steroids whereas numerically more inMinimalorMultiple Mildgroups were on oral steroids. RA Participant Characteristics around diagnosis by symptom clusters.Table 1.Baseline Values(mean SD, N %)MinimalN=38 (12%)Moderate PainN=124 (40%)Multiple Moderate-Severe N=114 (37%)Multiple MildN=34 (11%)SIGPatient Global (0-10)2.6 (2.4)4.8 (2.3)6.9 (2.0)3.9 (2.2)<0.0001PROMIS-29 Anxiety>551 (3%)15 (12%)108 (95%)28 (82%)<0.0001 Depression>550 (0%)14 (11%)100 (88%)22 (65%)<0.0001 Fatigue>553 (8%)49 (40%)106 (93%)12 (35%)<0.0001 Pain Interference>550 (0%)124 (100%)113 (99%)25 (74%)<0.0001 Physical Function<459 (24%)107 (86%)111 (97%)25 (74%)<0.0001 Participation<455 (13%)81 (65%)108 (95%)17 (50%)<0.0001 Sleep>552 (5%)46 (37%)88 (77%)17 (50%)<0.0001Physical Function (0-10)2.9 (2.3)6.1 (2.4)7.7 (1.9)4.2 (2.7)<0.0001Stiffness (0-10)3.2 (2.4)6.3 (2.4)7.7 (1.8)4.3 (2.3)<0.0001Oral steroids16 (42%)40 (32%)29 (25%)14 (41%)0.1470Parenteral steroids8 (21%)44 (35%)62 (54%)7 (21%)<0.0001TJC-28, median (IQR)8 (6,12)9 (5,13)9 (5,13)7 (5,12)0.4626SJC-28, median (IQR)7 (5,12)8 (4,12)7 (4,12)6 (3,11)0.4396CDAI, mean (SD)25.5 (11.4)29.2 (12.7)32.0 (14.0)24.8 (12.6)0.0103Substantial improvement was evident in 67% at 3 months (42%Minimal,25%Multiple Mild;Figure 1). At 6 months, 45% wereMinimaland 25%Multiple Mild. The best prognosis was forMinimal; almost all stayedMinimalat 3 (95%) and 6 (87%) months. Next best wasModerate Painwhere 71% improved (Minimal64%;Multiple Mild7%). A poorer prognosis was seen forMultiple Moderate-Severe: at 3 months, 61% improved (13%Minimal, 33%Multiple Mild).Multiple Mildalso were less likely to improve with 11%Minimaland 6% worsening by 3 months.Figure 1.ConclusionIn this large early RA cohort, we identified 4 distinct symptom clusters around diagnosis that were stable over 6 months and had distinct PRO profiles. At baseline, most (70%) participants were classified asModerate PainDominantorMultiple Moderate Symptoms; the remainder hadminimalormultiple mild symptoms. By examining symptom clusters, we found more homogeneous groups of patients. Our results also suggested that having multiple symptoms around diagnosis was associated with less improvement over the first 6 months, and may signal a more guarded prognosis for symptom improvement and HRQL in early RA.AcknowledgementsCATCH was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada since 2007; AbbVie Canada since 2011; Medexus since 2013; Sandoz Canada since 2019; Fresenius Kabi Canada since 2021; Organon Canada since 2021.Previous funding from Hoffman La Roche (2011-21); Sanofi Genzyme (2016-7); Eli Lilly Canada (2016-20); Merck Canada (2017-21) and; Gilead Sciences Canada (2020-21).Disclosure of InterestsSusan J. Bartlett Speakers bureau: Amgen, Janssen, Organon, Merck, Pfizer, Sandoz, Consultant of: Janssen, Merck, Organon, Sandoz, Clifton O Bingham: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Gilles Boire Speakers bureau: Merck, BMS, Pfizer, Janssen, Consultant of: Amgen, BMS, Celgene, Eli Lilly, Pfizer, Grant/research support from: Amgen, Abbvie, BMS, Eli Lilly, Merck, Novartis, Pfizer, Sandoz, Janet Pope Speakers bureau: UCB, Sandoz, Consultant of: AbbVie, Actelion, Amgen, Bayer, BMS, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Grant/research support from: Abbvie, BMS, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Consultant of: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Carter Thorne Consultant of: Abbvie, Amgen, Celgene, Centocor, Janssen, Lilly, Medexus/Medac, Merck, Novartis, Pfizer, Sanofi, Grant/research support from: Abbvie, Celgene, CaREBiodam, Novartis, Pfizer, Diane Tin: None declared, Carol Hitchon Grant/research support from: Pfizer and UCB, Glen Hazlewood: None declared, Edward Keystone Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Grant/research support from: AbbVie, Amgen, Gilead Sciences, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, PuraPharm, Sanofi, Vivian Bykerk Consultant of: Amgen, BMS, Gilead, Regeneron, UCB, Grant/research support from: Amgen, BMS, Genzyme, Pfizer, Regeneron Sanofi Aventis, UCB.

BackgroundNewly diagnosed RA patients seen in routine care may present with more tender than swollen joints, that can persist throughout their early RA treatment. Little is known, about the impact of these tender-swollen joint count differences (TSJD) on patient-reported outcome measures (PROMs), such as function, pain interference, social participation and other health-related quality of life (HR-QoL) outcomes.ObjectivesOur objective was to estimate the impact of TSJD on PROMs in the first year following RA diagnosis, and whether associations may vary by type of joint involvement (small vs large).MethodsData were from patients with active, early RA (symptoms<1 year, CDAI>2.8) enrolled in the Canadian Early Arthritis Cohort (CATCH) who completed detailed clinical assessments and PROMs including the PROMIS-29 (physical function, social participation, pain interference, fatigue, sleep disturbance, anxiety and depression) at baseline, 3-,6- and 12-month between Jan 2016 and Aug 2022. 28-tender and 28-swollen joint counts (including 6 large and 22 small-joints) were performed by rheumatology team members. TSJD were calculated by subtracting SJC from TJC at each visit and categorized as <=0, 1-4, 5-6, 7+. Adjusted associations between repeated measures of TSJD and PROMIS-29 HR-QoL domains were estimated in separate linear-mixed models adjusted for age, sex, education, smoking, comorbidities, osteoarthritis/back pain, and RA treatment. Stratified analyses by large vs small TSJD were also performed to examine potential differential impacts by joint distribution.Results547 eligible early RA patients (70% female, mean (SD) age 56(15) years, mean (SD) disease duration 5.3 (2.9) months) evaluated at baseline. 287 (52%) had TSJD score>0. Of these, scores ranged from 1 to 4 in 200 (37%), 5 to 6 in 41 (8%) and 7+ in 46 (8%). The frequency of TSJD>0 decreased from 52% at BL to 32% at 12-months. Adjusted mean-change scores in all PROMIS-29 measures were worse with higher TSJDs over 1-year follow-up (Figure 1). TSJD 1 to 4 and>7 were associated with worse mean-change T scores for all PROMIS29 outcomes, with TSJD>7 showing more pronounced worsening in physical function -2.6 [-4.0, -1.2] and participation satisfaction -3.5 [-5.3, -1.7] (negative scores indicating more impairment). Worse mean-change T scores in symptoms were also associated with TSJD>7 (positive scores indicating worse symptoms): pain interference 5.2 [3.5,6.9], fatigue 4.0 [2.1, 5.8], sleep problems 3.0 [1.4, 4.5], anxiety 2.1 [0.4, 3.8] and depression 2.0 [0.4, 3.7). There were fewer scores of TSJD 5 to 6, which was associated with worse mean-change scores in function, social participation and pain interference. The most striking mean-change scores were seen for large joint-TSJD scores of 5 to 6 in PROMIS function -6.1 [-10.3, -1.9] and social participation -6.1 [-11.6, -0.6], pain interference 6.6 [1.5, 11.7], compared to those found with small joint-TSJD and 28 joint-TSJD. Large joint -TSJD scores 1 to 4 were also associated with worse mean-change scores for all PROMIS measures.ConclusionOver half of patients with eRA have more tender than swollen joints, which persists in a third of patients. An increased TSJD score is associated with worse function, pain interference, social participation, and other HR-QoL outcomes over 1-year of follow-up. TSJD thresholds of 1 to 4 and>7 were associated with worsening of all PROMIS-29 outcomes. Having more tender than swollen large joints, at thresholds of 1 to 4 and 5 to 6, was associated with the most pronounced worsening of PROMs. Elevated TSJD assessment, especially in large-joints may help identify patients likely to experience worse outcomes. The impact from and persistence of predominantly tender joints supports a need to identify early interventions.REFERENCES:Hammer. Rheumatology Advances in Practice 2021:0;1-6.Figure 1.Acknowledgements:NIL.Disclosure of InterestsCharis Meng: None declared, Yvonne Lee Shareholder of: Cigna, Grant/research support from: Pfizer, other payment to medical writer from Sanofi Genzyme, Orit Schieir: None declared, Marie-France Valois: None declared, Margaret Butler: None declared, Gilles Boire Paid instructor for: Abbvie, BMS, Orimed Pharma, Viatris, Consultant of: Abbvie, BMS, Gilead, Janssen, Lilly, Mylan, Novartis, Pfizer, Samsung Bioepis, Sanofi, Teva, Viatris, Grant/research support from: BMS, Eli Lilly, Janssen, Merck, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Speakers bureau: AbbVie, Amgen, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Consultant of: AbbVie, Amgen, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Grant/research support from: Pfizer, UCB Public Health Agency of Canada, Research Manitoba, Health Sciences Centre Foundation, Edward Keystone Speakers bureau: AbbVie, Amgen, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Consultant of: AbbVie, Amgen, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Grant/research support from: Amgen, Merck, Pfizer Pharmaceuticals, Diane Tin: None declared, Carter Thorne Speakers bureau: Medexus/ Medac, Consultant of: AbbVie, Centocor, Janssen, Medexus; Novartis Pfizer; Sandoz; Sanofi, Grant/research support from: Pfizer, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Sanofi, Lilly, Novartis, TEVA, Fresenius Kabi, Sandoz, Organon, Consultant of: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Sanofi, Lilly, Novartis, TEVA, Fresenius Kabi, Sandoz, Organon, Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Janet Pope Speakers bureau: UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, BMS, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Grant/research support from: AbbVie, BMS, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, AbbVie, Vivian Bykerk Paid instructor for: Honoraria/Consulting: Amgen, Bristol Myers Squibb, Genzyme, Gilead, Janssen, Pfizer, Sanofi-Aventis, UCB;, Consultant of: Honoraria/Consulting: Amgen, Bristol Myers Squibb, Genzyme, Gilead, Janssen, Pfizer, Sanofi-Aventis, UCB;, Grant/research support from: institution received grants from Bristol Myers Squibb and Amgen.

BackgroundGrowing evidence points to considerable mental health impacts of the prolonged COVID-19 pandemic, though data from longitudinal studies in rheumatic diseases are sparse.ObjectivesWe explored distinct trajectories ofdepressive symptoms in the year prior to and throughout the first 2-years of the COVID-19 pandemic inadults with RA.MethodsCATCH is a prospective multi-center study of adults with early RA (symptoms <1 year; 81% met 2010 ACR/EULAR criteria at enrolment) who receive care from rheumatologists across Canada. Prior to the pandemic, participants completed PROs and rheumatologists conducted RA assessments during scheduled in-person study visits. After March 2020, ongoing collection of PROs continued at in-person and remote visits.We used group-based trajectory modeling to identify latent groups with at least mild depression (PROMIS 4a depression score ≥55) in participants with ≥1 visits in the year prior to the pandemic (3/19-2/20) and ≥1 visits during pandemic (3/20-1/22) and identified prepandemic individual and clinical characteristics and PROs associated with each trajectory.ResultsThe analytic sample included 989 participants with a mean (SD) age of 60 (14) and disease duration of 6 (4) years. 73% were women, 84% white, 60% had completed some post-secondary education, and 77% were in CDAI REM/LDA at visit closest to the start of pandemic.The best model included 4 groups (posterior probabilities ≥0.80 for each group): 1)Resilient(none-minimal depression throughout: N=594; 60%);Worsening(none/minimal to mild: N=222;22%);Improving(mild-resilient: N=80;8%); andPersistent(moderate-severe throughout: N=93;9%)(Figure 1).As compared with the Resilient group, those with Worsening Depression were more likely to be female, have a higher prepandemic CDAI, MD and patient global, and report worse pain, disability, anxiety, depression, fatigue, sleep disturbance, and lower participation (Table 1).Figure 1.Table 1.Mean(SD); N(%)Worsening N=222 (22%)Resilient N=594 (60%)Improving N=80 (8%)Persistent N=93 (9%)SIGAge60 (15)61 (13)59 (13)61 (13)0.538Female173 (78%)406 (68%)57 (71%)74 (80%)0.016White194 (87%)533 (90%)67 (84%)71 (76%)0.004Education > high school143 (64%)388(65%)56 (70%)42 (45%)0.001RDCI (excl depression)1.2 (1.2)1.0 (1.2)1.0 (1.1)1.0 (1.1)0.174CDAI6.7 (8.2)5.4 (8.5)11.3 (13.9)13.0 (13.1)<0.001csDMARDs ±MTX198 (89%)547 (92%)73 (91%)67 (94%)0.513MTX only153 (69%)436 (73%)62 (78%)67 (72%)0.443Biologic or JAK43 (19%)102 (17%)12 (15%)26 (28%)0.073Corticosteroids36 (16%)86 (14%)26 (33%)20 (22%)0.001Patient Global3.1 (2.4)1.2 (2.1)3.9 (2.9)5.3 (2.7)<0.001PROMIS Anxiety >5597 (44%)44 (7%)58 (73%)86 (92%)<0.001PROMIS Depression >5583 (37%)13 (2%)70 (88%)90 (97%)<0.001PROMIS Fatigue >5583 (37%)94 (16%)42 (53%)74 (80%)<0.001PROMIS Pain >55125 (56%)187 (31%)55 (69%)76 (82%)<0.001PROMIS Physical Function <45132 (59%)238 (40%)51 (64%)78 (84%)<0.001PROMIS Participation <45107 (48%)141 (24%)49 (61%)72 (77%)<0.001PROMIS Sleep Problems >5562 (28%)88 (15%)33 (41%)so (54%)<0.001ConclusionAlthough 60% of Canadian RA patients had consistently good mental health during the first 2 years of the COVID-19 pandemic, more than 1 in 5 reported deteriorating mood suggesting a cumulative impact over time; 9% had persistent depression and 8% improving mood. The proportion of adults with RA with at least mild symptoms of depression may be more than twice that reported for the general Canadian population. Participants with worsening depressive symptoms during the pandemic were more likely to be female, have higher prepandemic disease activity, symptoms, disability, and higher impairments in participation. Given the impact of depression on quality of life, inflammation, and disease management, vulnerable groups may benefit from more frequent evaluation and additional support from rheumatology providers.AcknowledgementsCATCH was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada since 2007; AbbVie Canada since 2011; Medexus since 2013; Sandoz Canada since 2019; Fresenius Kabi Canada since 2021; Organon Canada since 2021.Previous funding from Hoffman La Roche (2011-21); Sanofi Genzyme (2016-7); Eli Lilly Canada (2016-20); Merck Canada (2017-21) and; Gilead Sciences Canada (2020-21).Disclosure of InterestsSusan J. Bartlett Speakers bureau: Janssen, Merck, Organon, Pfizer, Sandoz, Consultant of: Janssen, Merck, Organon, Orit Schieir: None declared, Marie-France Valois: None declared, Janet Pope Speakers bureau: UCB. Sandoz, Consultant of: AbbVie, Actelion, Amgen, Bayer, BMS, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Grant/research support from: Abbvie, BMS, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilles Boire Speakers bureau: Merck, BMS, Pfizer, Janssen, Consultant of: Amgen, BMS, Celgene, Eli Lilly, Pfizer, Grant/research support from: Amgen, Abbvie, BMS, Eli Lilly, Merck, Novartis, Pfizer, Sandoz, Carol Hitchon Grant/research support from: Pfizer, UCB, Edward Keystone Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Grant/research support from: AbbVie, Amgen, Gilead Sciences, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, PuraPharm, Sanofi, Carter Thorne Speakers bureau: Medexus/Medac, Consultant of: Abbvie, Amgen, Celgene, Centocor, Janssen, Lilly, Mexexus/Medac, Merck, Novartis, Pfizer, Sanofi, Grant/research support from: Abbvie, Celgene, CaREBiodam, Diane Tin: None declared, Glen Hazlewood: None declared, Vivian Bykerk Grant/research support from: Amgen, BMS, Genzyme, Pfizer, Regeneron Sanofi Aventis, UCB.

BackgroundA growing number of studies indicate the considerable mental health impacts of the prolonged COVID-19 pandemic in the general population as chronic stress is a risk factor for the development of depression and anxiety. Mood disorders are more prevalent in RA and a history of anxiety or depressive disorders increases the risk of recurrence in the future.ObjectivesTo compare trends in prevalence of anxiety and depressive symptoms, prior to and during the COVID-19 pandemic in RA patients with and without a lifetime history of mood disorders.MethodsData were from RA patients diagnosed and treated for RA in rheumatology clinics across Canada enrolled in the Canadian Early Arthritis Cohort (CATCH) Study. We estimated monthly trends in prevalence of clinically significant levels of anxiety and depression (PROMIS Depression and Anxiety 4a score 55+) from all visits between Mar 2019 and Jan 2022 and compared monthly trends in anxiety and depression in the year prior to (Mar 2019- Feb 2020) and during the pandemic (Mar 2020 to Jan 2022) stratified by lifetime history of mood disorders.Results4,148 visits were completed from Mar 2019 to Jan 2022 in 1,644 RA patients with a mean (SD) age of 60 (14) and disease duration of 6 (4) years. 73% were women, 84% white, 60% had completed some post-secondary education, and 77% were in CDAI REM/LDA at the visit closest to the start of pandemic. 253 (15%) reported a lifetime history of depression and 217 (13%) a lifetime history of anxiety; 8% reported prior treatment for either.Patients with a history of mood disorders had higher levels of depression and anxiety prior-to and during the pandemic compared with patients without a history of mood disorders (Table 1). Proportions were highest during COVID waves in all and were substantially higher and more variable in people with a previous history of mood disorders as compared to those without a history (Figure 1). While depressive symptoms peaked early in the pandemic, anxiety increased with each wave, peaking in Wave 3 (May-Jun 2021).Table 1.Prevalence of depression and anxiety symptoms prior to and during the COVID-19 pandemic in RA patients with and without a history of mood disorders.Period Prevalence (monthly range)DepressionAnxietyNo historyPrior HistoryNo HistoryPrior HistoryN observations35276213610538Prepandemic (3/19 - 2/20)21%(14%-30%)51%(29%-64%)27%(20%-35%)58%(31%-89%)Pandemic (3/20 - 1/22)22%(15%-29%)53%(33%-78%)28%(20%-43%)59%(33%-80%)Figure 1.During the first 22 months of the COVID-19 pandemic, the proportion of patients with depression and anxiety increased in all groups. More than half of those with a history of emotional distress had clinically significant levels of depression and anxiety; proportions were highest during COVID waves in all and were substantially higher in people with previous history as compared to those without a history (see Figure 1). Whereas depressive symptoms peaked early in the pandemic, anxiety increased with each wave, peaking in Wave 3 (May-Jun 2021).ConclusionSymptoms of anxiety and depression were common in Canadian adults with RA prior to and after the onset of the COVID-19 pandemic. Whereas others have found that high levels of depression and anxiety occurred early in the pandemic but declined fairly rapidly in the general population1, emotional distress was not attenuated over time in this large cohort of RA patients. Individuals reporting lifetime history of mood disorders were more than twice as likely to report anxiety and depression, with depression peaking early in the pandemic and anxiety growing with each successive wave in the first year. The results demonstrate the importance of applying a lifetime perspective as previous episodes of anxiety and depression may be an important marker of increased vulnerability and recurrence in RA patients, particularly during the pandemic.References[1]Fancourt D et al. Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England. Lancet Psychiatry. 2021;8:141-9.AcknowledgementsCATCH is supported through unrestricted research grants from: Amgen and Pfizer Canada since 2007; AbbVie Corporation since 2011; Medexus since 2013; Sandoz Canada since 2019; Fresenius Kabi Canada since 2021 and; Organon Canada since 2021. Previous funding from Janssen Canada (2011-16); UCB Canada and Bristol-Myers Squibb Canada (2011-18); Hoffman La Roche Limited (2011-21); Sanofi Genzyme (2016-17); Eli Lilly Canada (2016-20); Merck Canada (2017-21) and; Gilead Sciences Canada (2020-21)Disclosure of InterestsNone declared

BackgroundDuring the COVID-19 pandemic, Canadians with RA faced considerable uncertainty due to greater risk of infection, hospitalization, changing access to RA medications, and very limited access to in-person RA care. Further, to reduce transmission of the virus and COVID-related hospitalizations, stringent mitigation measures were implemented across the country to greatly reduce social contacts including curfews, limits on private gatherings and business closures. Little is known about the impact of the COVID-19 pandemic and associated mitigation efforts in RA. We hypothesized that women and younger adults with RA would report greater impairments in HRQL.ObjectivesTo compare changes in HRQL prior-to and during the COVID-19 pandemic by sex and age groups in real-world RA patients seen in routine practice settings.MethodsData were from patients in the Canadian Early Arthritis Cohort (CATCH) who completed a study visit in the year prior to the COVID-19 pandemic (Mar 2019 through Feb 2020) and a repeat assessment during the pandemic period (Mar 2020 – Jan 2022). RA disease activity was assessed using the RA Flare Questionnaire, a validated patient-reported measure of current RA disease symptoms (pain, stiffness, fatigue) and function (physical, participation). An RA-FQ score ≥ 20 was used to classify RA symptoms consistent with an RA inflammatory flare. HRQL was assessed using PROMIS-29 Adult Profiles. We compared changes in mean Physical (PHS) and Mental Health (MHS) scores, and the proportion of patients with impairments in each domain (i.e., scores ≥ 55 for pain interference, fatigue, anxiety, depression, and sleep and ≤45 for physical function and participation) before and during the COVID-19 pandemic across sex and age groups (<40, 40-64, ≥65 years).ResultsThe 938 CATCH participants in the analytic sample with data available at both time periods had a mean (SD) age of 60 (13) and RA symptom duration of 5.8 (3.7) years; 72% were women, 88% were white, and 64% reported >high school education. Most (80%) were in CDAI REM/LDA at the most recent visit prior to start of pandemic. The proportion of patients with RA-FQ ≥20 were similar at both time periods. While physical and emotional RA symptom impacts remained stable in men prior to and during the COVID-19 pandemic, women reported significant increases in anxiety and depression during the pandemic period. Younger RA patients <40 reported increases in depression, and older RA patients (65+) reported increases in anxiety and greater impacts on participation.ConclusionOur results illustrate that while the proportions of patients with high inflammatory disease activity were similar prior to and during the COVID-19 pandemic, we observed disproportionate impacts on HRQL by sex and age with a higher proportion of women, adults <40, and those ≥65 years of age experiencing greater impairments in several HRQL domains.Table 1.DomainWomen (N = 673)Men (N=265)Age <40 (N=84)Age 45-64 (N=492)Age 65+ (N= 362)BeforeDuringBeforeDuringBeforeDuringBeforeDuringBeforeDuringRA Flare >20%17%21%19%18%13%7%18%21%18%21%Anxiety34%*42%*23%23%42%55%32%35%28%*35%*Depression28%*34%*22%20%25%*42%*28%28%24%30%Fatigue36%38%24%23%43%43%36%33%26%32%Pain47%52%48%45%39%48%46%49%49%54%Physical function54%57%46%46%40%40%49%50%59%62%Participation42%47%34%36%37%38%40%41%40%*49%*Sleep30%34%18%22%26%29%29%33%23%28%*p <0.05AcknowledgementsCATCH is supported through unrestricted research grants from: Amgen and Pfizer Canada since 2007; AbbVie since 2011; Medexus since 2013; Sandoz Canada since 2019; Fresenius Kabi Canada since 2021 and; Organon Canada since 2021. Previous funding from Janssen Canada (2011-16); UCB Canada and Bristol-Myers Squibb Canada (2011-18); Hoffman La Roche (2011-21); Sanofi Genzyme (2016-17); Eli Lilly Canada (2016-20); Merck Canada (2017-21) and Gilead Sciences Canada (2020-21)Disclosure of InterestsNone declared