ABSTRACT
BackgroundIn recent years despite improved therapies for RA, there is an increased awareness of persistent pain in people with RA. Before the pandemic we assessed a large group of patients with RA with comprehensive joint ultrasound (US) and for presence of fibromyalgia (FM) meeting 2010 ACR diagnostic criteria. When combinations of synovitis and/or FM were made we noted 4 groups of patients. As well as some with only FM, we also noted a group we believe had peripheral non-inflammatory pain, a new concept in RA. Here we investigate if these different groups change over time in our T2T routine care pathway.ObjectivesTo assess the progress and outcomes patients with RA with different well defined pain states during 4 years of follow up including the COVID19 pandemic.MethodsThe TITRATE-ULTRASOUND patient cohort categorised patients with RA into 4 groups depending on the presence or absence FM and the presence or absence of power doppler synovitis (PD, defined as positive PD signal in ≥2 joints in a 44 joint US). We identified 72 patients with active RA (DAS28 3.2 – 5.1) from this cohort with sufficient clinical data during the study period and collected the following data on each follow up encounter: visit type, treatment changes and disease activity measures. In the COVID19 pandemic follow up visits were largely virtual without the ability to collect physician assessed disease activity scores. Progress assessment was performed as to whether the patient had improved, no change or worse with a numerical value of +1, 0 and -1 at each visit to calculate a score tracking patient progress during the pandemic. Statistical analysis was performed using 1-way ANOVA to assess for difference between the 4 groups.Results72 patients with were assigned into the following categories: FM-PD-, 12 (peripheral pain group);FM-PD+,18;FM+PD-, 29;FM+PD+, 13. Table 1 shows baseline characteristics of the 4 groups and reveals no significant difference by ANOVA between the 4 groups in total visits, face to face visits, telephone visits, tender joint count, treatment escalations, steroid prescriptions, csDMARD prescriptions, and progress score. Biologic prescriptions did vary significantly between the groups (p = 0.009).Table 1.FM-PD- (n=12)FM-PD+ (n=18)FM+PD- (n=29)FM+PD+ (n=13)ANOVA p-valueFemale (n, %)10 (83%)13 (72%)24 (83%)13 (92%)CCP+ve (n, %)4 (33%)12 (67%)14 (48%)6 (46%)Disease duration (years) (mean, SEM)11.04 (2.676)16.19 (2.889)12.29 (1.709)16.23 (3.340)On csDMARD (n, %)11 (92%)15 (83%)24 (83%)10 (77%)On bDMARD (n, %)4 (33%)5 (28%)7 (24%)8 (61.5%)Baseline DAS28 (mean, SEM)4.412 (0.1641)4.344 (0.1177)4.192 (0.08910)4.366 (0.1461)Total visits (mean, SEM)11.67 (2.647)10.50 (2.031)8.724 (1.039)8.308 (1.407)0.533F2F visits (mean, SEM)7.909 (2.164)7.944 (1.924)5.793 (1.033)5.769 (1.311)0.5959Telephone visits (mean, SEM)4.417 (1.474)2.556 (0.3154)2.931 (0.3327)2.538 (0.6162)0.2268Tender joint count (mean, SEM)3.604 (1.101)3.506 (0.6177)5.376 (0.6899)4.603 (1.246)0.3179Treatment escalations (mean, SEM)2.917 (1.062)3.722 (1.028)2.000 (0.5526)1.615 (0.6257)0.2671Steroid prescriptions (mean, SEM)1.833 (0.7160)1.611 (0.5310)1.000 (0.3908)0.7692 (0.5329)0.503csDMARD prescriptions (mean, SEM)0.7500 (0.3046)0.7778 (0.2070)0.5185 (0.1634)0.3636 (0.2787)0.5789Biologic prescriptions (mean, SEM)0.3333 (0.2247)1.778 (0.6291)0.3793 (0.1257)0.3077 (0.2371)0.009Progress score (mean, SEM)-1.167 (1.461)0.6111 (0.3889)-0.1379 (0.2366)0.4615 (0.6265)0.2579ConclusionOver the follow-up period we show the management of RA patients without active power doppler synovitis or fibromyalgia did not differ significantly from other categories of patients. Similar numbers of visits, treatment escalations, csDMARDs and corticosteroid prescriptions were observed. This illustrates how it can be difficult to define the specific causes of disease activity without access to US. Despite similar management strategies, FM-PD- patients tended towards worse progress scores, suggesting a potential unmet need in such patients.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of In erestsMark Gibson: None declared, Nadia Ladha Hassan: None declared, L Bruce Kirkham Speakers bureau: Abbvie, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, UCB, Grant/research support from: Eli Lilly.