Ab0174 most Rheumatoid Arthritis Patients in Post–2010 Reports From Routine Care Remain in Das28, Cdai or Rapid3 Moderate Activity/Severity, Not Low/Remission: Explained in Part by Limits of Indices and/or Strategies for Diagnosis and Treatment?

Abstract

BackgroundAvailability of powerful biological agents to treat rheumatoid arthritis (RA) has led to a strategy of treat-to-target toward remission or low disease activity according to a quantitative index, although higher levels of disease activity according to shared decisions are recognized as appropriate for certain patients.1 Substantial improvement in patient status was documented quantitatively in 2000 compared to 1985,2 maintained in 20083 and 20104, but few reports in recent years compare patient status in routine care to earlier data.ObjectivesTo analyze post-2010 reports concerning mean or median or categories of DAS28, CDAI, and RAPID3 to depict patient status, and compared to pre-2011 reports.MethodsPubMed searches were conducted for 2011-2021 reports for “DAS28 (disease activity score) categories not trial,” and repeated twice, replacing “DAS28” with “CDAI” (clinical disease activity index) and “RAPID3” (routine assessment of patient index data). Activity/severity levels for high, moderate, low, and remission, respectively, are: DAS28 (0-10) >5.1, 3.2–5.1, 2.6–3.2, ≤2.6; CDAI (0-76) >22, 10.1–22, 2.9-10, ≤2.8; RAPID3 (0-30) >12, 6.1–12, 3.1-6, ≤3.0. Mean and/or median DAS28, CDAI, or RAPID3, and/or proportions of patients who were in remission, low, moderate, and high activity/severity were compiled. Results were compared to 3 pre-2011 reports, 2 of which included all 3 indices.2-4ResultsResults from 1985 vs 2000 indicate >50% improvement in swollen joints and physical function,2 maintained in 20083 and 20104 (data not shown). The search identified 32 reports with 98 comparisons of 1, 2, or 3 indices for mean or median levels or activity/severity categories (Table). Analyses of 57 means or medians indicated 10 high, 39 moderate, 8 low; for DAS28-ESR 2, 18, 2; for DAS28-CRP 1, 6, 3; for CDAI 4, 9, 3; and for RAPID3 3, 6, 0 (Table). Analyses of 41 reports of comparisons of disease activity/severity categories indicated more high/moderate in 35 vs low/remission in 6, 1 of 5 for DAS28–CRP and 5 of 15 for CDAI (Table). Remission according to DAS28, CDAI, or RAPID3 was reported in 17.1%, 10.2%, and 13.7% of patients, respectively, and low activity/severity or remission in 33.3%, 39.6%, and 29.7%, respectively (data not shown).Table 1.Means and/or Medians and categories of DAS28-ESR, DAS28-CRP, CDAI and RAPID3.Index:# of compa-risonsDAS28-ESRDAS28-CRPCDAIRAPID3Mean/Median of IndexTotal means and medians572210169High activity/severity102143Moderate activity/severity3918696Low activity/severity82330Remission00000Categories of High or Moderate Activity/Severity vs Low or RemissionTotal classified by categories41125159High or Moderate>Low or Remission35124109Low or Remission>High or Moderate60150ConclusionMost RA patients in post 2011 reports from routine care were in moderate activity according to means or medians or categories, unchanged from 2008 and 2010. Only a minority were classified as in remission or low activity/severity. Optimal RA treatment may require modification of treatment goals, further recognition of differences between patients in clinical trials and routine care, and possible new strategies for earlier identification of RA patients for treatment, in addition to new therapeutic agents.References[1]Smolen JS et al. Ann Rheumatic Dis. 2010;69(4):631-7.[2]Pincus T et al. Arthritis and Rheumatism. 2005;52(4):1009-19.[3]Pincus T et al. J Rheumatol. 2008;35(11):2136-47.[4]Pincus T et al. Arthritis Care & Research. 2010;62(2):181-9.Disclosure of InterestsNone declared