Ab0275 rheumatoid Arthritis in Hispanic Patients: Demographic and Baseline Clinical Characteristics in an Early Referral Cohort in Mexico Versus Routine Care in the United States

Abstract

BackgroundHispanics are the largest minority group in the United States (US) and his percentage is expected to increase (28.6% by 2060)1, being Mexicans the largest group (67.9%). RA patients from Latin-America have distinctive features from White patients. The literature highlights a younger age at presentation and a different clinical expression compared with White2 but few data for Hispanic patients in US are available.ObjectivesWe compared baseline demographic, clinical features and disease management among Hispanic RA patients from two well characterized cohorts, in the USA and Mexico city.MethodsAn early arthritis clinic (EAC) was established at Site 1 (Mexico City); patients with recent-onset RA (<1 year of symptoms) had a standardized assessment and received “treat to target” treatment. At Site 2 (US), a “routine care” cohort was initiated in 2011, and all patients completed a multidimensional health assessment questionnaire (MDHAQ) as part of their routine care. Patients from both sites had baseline complete evaluation including sociodemographic data, patient-reported outcomes (PROs) (patient global assessment, pain-VAS, HAQ/MHAQ, RAPID3), laboratory data, and tender joint counts. Initial treatment was noted. Data from both sites were compared and appropriate statistics was used.Results201 patients from site 1 and 179 from site 2 were included (table 1); among them, 105 (52%) and 37 (19%), respectively, were DMARDs-naïve at baseline. Patients from site 2 were older and had longer disease duration, however demographic characteristics did not differ. Naïve-DMARDs patients from site 2 scored significantly higher pain-VAS and tender joint counts, and had higher ESR values (p≤0.05, Mann Withney); a similar tendency was seen for other PROs. Time to DMARDs initiation was shorter in the EAC.Table. Demographic and clinical characteristics at first rheumatology visit for RA patients. All data as median (IQR) unless otherwise indicated. *p ≤ 0.003. NA, not applicable Site 1: Mexico-Early Arthritis Clinic Site 2: US-RA Routine Care Patients on DMARDN=96DMARD NaïveN=105Patients on DMARDN=142DMARD NaïveN=37 DEMOGRAPHICS Age, years, mean (SD)38.6 (13)38.8 (12.9)55.7 (15.4)45.5 (12.6)Female,%87.5%93%87%83%Yrs of formal education12 (9,16)12 (9, 14)12 (9, 14)12 (9.5, 14)Symptom duration-first visit, mo5.6 (3.9, 7.9)4.7 (2.9, 6.5)NA22.7 (3.0, 47.9)% treated as early RA (<6m)59.470NA34 PROs Pain (0-10)4.2 (2.4, 6)6.2 (3.8, 7.8)6 (2.7, 8)8 (6, 8.5)Patient global assessment (0-10)4.4 (2.3, 6.8)6.7 (3.9-8.2)5.5 (2.5, 8)7.5 (4, 8.5)Tender Joint Counts (TJC28 or self-reported RADAI48)11 (6, 18)14 (9, 20)12 (3, 24)20 (7,32)RAPID3 (0-30)11.0(6.8-16.3)15.5(10.3-19.1)13.6(6, 20)15.3(10, 21.5)Physical Function-MHAQ (0-10)2.2 (1-4)3 (1.3-4.3)3.0 (0.6, 4.2)2.4 (1.2, 4.8) SEROLOGIC DATA RF,%82827572ACPA,%84866781ESR, mm/hr21.5 (11, 48)23 (12.5, 38)NA35.5 (14, 55)CRP, mg/dl0.68(0.22, 2.22)0.67(0.27, 2.48)NA0.69(0.54, 1.23) TREATMENT MTX,%8993NA63*Other DMARDs,%5966NA44*Prednisone,%Mean dose (SD), mg477.5 (2.3)597.7 (3.5)NA80*9.3 (3.4)Tim...

Ab0275 rheumatoid Arthritis in Hispanic Patients: Demographic and Baseline Clinical Characteristics in an Early Referral Cohort in Mexico Versus Routine Care in the United States

“…Conflicting non-statistically significant associations between age and response were found (Figure 1a). [1][2][3][4] Female gender was found to be a predictor of non-response in two studies (OR (odds ratio) 0.55 and 0.54), but these findings could not be replicated in two other studies (Figure 1b). [1][2][3][4] In two studies, smoking predicted non-response (adjusted OR 0.35 and 0.60), but this was inconsistent over all response criteria assessed (Figure 1c).…”

“…[1][2][3][4] Female gender was found to be a predictor of non-response in two studies (OR (odds ratio) 0.55 and 0.54), but these findings could not be replicated in two other studies (Figure 1b). [1][2][3][4] In two studies, smoking predicted non-response (adjusted OR 0.35 and 0.60), but this was inconsistent over all response criteria assessed (Figure 1c). 3,5 Higher disease activity score was a predictor of response in two studies (adjusted OR 1.12 and 2.7), conflicting and non-statistically significant predictive values were found in two other studies (Figure 1d).…”

“…3,5 Higher disease activity score was a predictor of response in two studies (adjusted OR 1.12 and 2.7), conflicting and non-statistically significant predictive values were found in two other studies (Figure 1d). [2][3][4]6 Rheumatoid factor positivity predicted non-response in two studies (adjusted hazard ratio 0.61, adjusted OR 0.4), although this was not found in three other studies. [2][3][4]7,8 Heterogeneity between studies prohibited pooling of predictive values.…”

“…[2][3][4]6 Rheumatoid factor positivity predicted non-response in two studies (adjusted hazard ratio 0.61, adjusted OR 0.4), although this was not found in three other studies. [2][3][4]7,8 Heterogeneity between studies prohibited pooling of predictive values. Additionally, a validated epigenetic model was found: area under the receiver operating characteristic curve 0.90 in the development cohort and 0.91 in a validation cohort.…”