P210 Morbidity and mortality in rheumatoid arthritis: review of data from ‘Basildon Early Inflammatory Arthritis Cohort’

Abstract

Abstract Background/Aims Rheumatoid arthritis is a chronic inflammatory autoimmune condition associated with multi-system involvement, cardiovascular risk, worsening quality of life measures and increased mortality. Analysing registry data helps identify parameters that may contribute to morbidity and mortality. Recognising limitations in current treatment could facilitate development of new management strategies. Objective is to assess long-term outcome of patients diagnosed with rheumatoid arthritis in ‘Early Arthritis Cohort’ at a district general hospital in UK. Methods A retrospective cohort study was conducted on 185 patients newly diagnosed with rheumatoid arthritis between 2009 & 2013. Anonymised data from the Basildon Early Arthritis registry were analysed. Measured parameters included patient demographics, disease activity score (DAS28), laboratory and imaging investigations, treatment regime, development of new disease manifestations & mortality. Results Complete data were available for analysis in 157 patients. This comprised 56 men & 101 women with median age of 57 years (Q1 = 47 years, Q3 = 67 years) and median follow-up time of 93 months (Q1 = 67 months, Q3 = 108 months). At baseline, 40.1% of patients had DAS28 score > 5.1, whilst 2.5% had DAS28 score > 5.1 at time of their last follow up. 74% of patients were in clinical remission at time of their last follow up, with the majority continuing to require pharmacological therapy, either as single DMARD 39.5%, combination csDMARD 29.3% or biologic therapy 17.2%. Drug-free remission was achieved in 14% of patients. Analysis of new comorbidities revealed cancer burden with 14.6% (23/157) developing malignancy, lung cancer having highest incidence 5.7% (9/157). 39% of the cohort were current or ex-smokers. Other malignancies included prostate, haematological and breast cancers. Cardiac involvement was noted in 11.5% with incidence of ischaemic heart disease at 7% (11/157) and heart failure at 4.5% (7/157). Cerebrovascular and pulmonary diseases were detected in 5.7% (9/157) and 5.1% (8/157) respectively. A mortality rate of 21% (33/157) was observed in our cohort. Patients in the mortality group had median baseline age of 72 as compared to 53 for remaining cohort. This age difference did not reach statistical significance. Duration of illness prior to death was less than 5 years in 45% of patients and between 5-10 years in 55% of patients. Predominant cause of death was underlying malignancy 8.3% (13/157), ischaemic heart disease 3.8% (6/157), frailty 3.2% (5/157), and pulmonary disease 2.5% (4/157). The DAS28 score was found to be significantly higher in the mortality group compared to remaining cohort (p = 0.006). Conclusion Long-term outcomes in patients with rheumatoid arthritis recruited from early arthritis cohort reveal mortality rate of 21% and cancer burden of 14.6%. Patients in the mortality group displayed significantly higher DAS28 scores at time of their last follow-up. Disclosure D. Laila: None. K. Jain: None. A. Nandagudi: None. A. Bharadwaj: None.