Outcomes In Rheumatoid Arthritis Patients Research Articles

New Insight into the Effects of Different Types of Midfoot and Hindfoot Deformities on the Functional Outcomes of Rheumatoid Arthritis Patients

New Insight into the Effects of Different Types of Midfoot and Hindfoot Deformities on the Functional Outcomes of Rheumatoid Arthritis Patients

New Insight into the Effects of Different Types of Midfoot and Hindfoot Deformities on the Functional Outcomes of Rheumatoid Arthritis Patients

In advanced stages of rheumatoid arthritis (RA), the pattern of joint involvement leads to varied types of foot deformities such as forefoot, midfoot, and hindfoot deformities. We aim to evaluate midfoot and hindfoot deformities and their effect on functional outcomes in RA patients. In this prospective cross-sectional study clinical and radiological evaluations of 100 adult RA patients were studied for midfoot and hindfoot deformities. The RA disease activity, functional disability level, specific foot and ankle assessments, gait speed, and balance tests were assessed. Radiological examinations of the weight-bearing feet in a standing position were done. We found that the most frequent deformity type was the planovalgus foot (24%). There were statistically significant differences between the types of foot deformities and disease duration, disease activity, falls, Tinetti and Berg balance Test, and health assessment questionnaire-disability index. The multivariate regression analysis of independent correlates of falling detected that patients with equinovarus deformity were 2.5 times more liable for falling with 63.5% predictive power. According to the predictive criteria of deformity type for falling, the equinocavovarus type had accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 84.5%, 98.5%, 99%, and 84%, respectively. We found in RA patients, midfoot and hindfoot deformities cause a significant reduction of functional ability and quality of life. The early detection of foot deformities requires a good awareness of the clinical and radiographic diagnosis of different types of deformities thus reducing the possible functional disabilities via early management by combined orthotic, physiotherapy, and surgical treatments. Level of Clinical Evidence4

Evaluating the influence of a structured nursing protocol on targeted outcomes in rheumatoid arthritis patients

Objective: Rheumatoid arthritis (RA) requires comprehensive management. Structured nursing protocols may enhance outcomes, but evidence is limited. This study evaluated the effect of a structured nursing protocol on RA outcomes. Materials and Methods: In this one-group pre-post study, 30 Egyptian RA patients completed assessments before and after a 12-week nursing protocol comprising education, psychosocial support, and self-management promotion. Assessments included clinical evaluation of joint counts, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) and patient-reported Arthritis Self-Efficacy Scale (ASES), Health Assessment Questionnaire (HAQ), Visual Analog Scale (VAS) for pain, and Hospital Anxiety and Depression Scale (HADS). Results: The study demonstrated significant improvements in both clinical- and patient-reported outcomes. Joint count decreased from 18.4 ± 4.2 to 14.2 ± 3.8 (P < 0.001), ESR from 30.1 ± 6.8 mm/h to 25.5 ± 6.8 mm/h (P < 0.01), and CRP levels from 15.2 ± 3.6 mg/L to 11.8 ± 2.9 mg/L (P < 0.01) postintervention. Patient-reported outcomes showed a marked increase in ASES score from 140 ± 25 to 170 ± 30 (P < 0.001) and reductions in HAQ from 1.6 ± 0.4 to 1.3 ± 0.3 (P < 0.01), VAS pain score from 7.8 ± 1.7 to 6.2 ± 1.2 (P < 0.001), and HADS anxiety and depression scores from 11 ± 3 to 8 ± 2 (P < 0.05) and 10 ± 2 to 7 ± 1 (P < 0.05), respectively. Conclusion: A structured nursing protocol significantly improved clinical disease activity, physical functioning, pain, self-efficacy, and emotional well-being in RA patients. A multifaceted nursing intervention appears beneficial for optimizing RA outcomes.

Ten-year radiographic and functional outcomes in rheumatoid arthritis patients in remission compared to patients in low disease activity

BackgroundTo compare the 10-year structural and functional prognosis between patients in sustained remission versus patients in sustained low disease activity (LDA) in early rheumatoid arthritis (RA).MethodsWe included 256 patients from the ESPOIR cohort who fulfilled the 2010 ACR/EULAR criteria for RA and who were in sustained remission using the Simple Disease Activity Index (SDAI) score (n = 48), in sustained LDA (n = 139) or in sustained moderate to high disease activity (MDA or HDA, n = 69) over 10 years. The mTSSs progression over 10 years and the 10-year HAQ-DI scores were compared between the 3 groups. A longitudinal latent process mixed model was used to assess the independent effect of SDAI status over time on 10-year mTSS progression and HAQ-DI at 10 years.ResultsPatients in sustained remission group were younger, had lower baseline HAQ-DI and mTSS scores and were less exposed to glucocorticoids, methotrexate or biologic disease-modifying anti-rheumatic drugs over 10 years. Patients in sustained remission had lower 10-year structural progression (variation of mTSS in the remission group: 4.06 (± 4.75) versus 14.59 (± 19.76) in the LDA group and 21.04 (± 24.08), p < 0.001 in the MDA or HDA groups) and lower 10-year HAQ-DI scores (10-year HAQ-DI in the remission group: 0.14 (± 0.33) versus 0.53 (± 0.49) in the LDA group and 1.20 (± 0.62) in the MDA or HDA groups, p < 0.001). The incidence of serious adverse events over 10 years was low, about 3.34/100 patient years, without any difference between the three groups.ConclusionRA patients in sustained SDAI remission have better long-term structural and functional outcomes in comparison to patients in sustained LDA.

Discordance of global assessment between the patients and physicians predicts 9-year pain-related outcomes in rheumatoid arthritis patients.

Perspectives regarding the disease state often differ between patients with rheumatoid arthritis (RA) and physicians. The aim of the present longitudinal cohort study was to investigate the impact of the discordance in global assessments between patients and physicians on 9-year pain-related outcomes in patients with rheumatoid arthritis. Sixty-eight consecutive outpatients with rheumatoid arthritis on their first visit to a tertiary center were included. Baseline measurements included demographic data, drugs used, disease activity, and a modified Health Assessment Questionnaire (mHAQ). Discordance in global assessment between patients and physicians at baseline was defined as 10 mm higher in the patient global assessment (PGA) than in the physician global assessment. A 9-year follow-up assessment included pain intensity, the European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) scale, Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Disability Assessment Scale (PDAS), and Pain Self-Efficacy Questionnaire (PSEQ). The number of patients with discordance was 26 (38%) in 68 patients. Patients with a 10 mm higher PGA than the physician global assessment at baseline measurements had significantly worse pain intensity, PCS score, PSEQ score, and EQ-5D-3L score measurements at the 9-year follow-up than those with concordance. A higher mHAQ score and 10 mm higher PGA at baseline were significantly independently associated with the EQ-5D-3L scale score and pain intensity at the 9-year follow-up. This longitudinal cohort study suggested that discordance in global assessment between patients and physicians modestly predicted worse 9-year pain-related outcomes in patients with rheumatoid arthritis.

Impact of a hybrid medical care model in the rheumatoid arthritis patient-reported outcomes: A non-inferiority crossover randomized study.

Patients and physicians can naturally adopt hybrid healthcare models that combine face-to-face consultations with telemedicine. The study's objective was to compare the impact of two healthcare interventions, hybrid care modality and face-to-face consultation, on the patient-reported outcomes of rheumatoid arthritis patients, during the COVID-19 pandemic. Consecutive outpatients reincorporated to a clinic previously in lockdown were invited to a non-inferiority, randomized study (October 2020--May 2022). Patients were randomized to 6 months of face-to-face consultation or hybrid care modality (intervention period-1) and then the converse modality (intervention period-2). The primary outcome was disease activity/severity behavior (Routine Assessment of Patient Index Data 3). Additional patient-reported outcomes were disability (Health Assessment Questionnaire Disability Index), quality-of-life (World Health Organization quality of life questionnaire-brief version), adherence and satisfaction with medical care, and treatment recommendation. Sample size calculation established 55 patients/healthcare interventions. There were 138 patients invited to participate, 130 agreed and 121 completed their study participation. Sixty-one and 60 patients respectively, received face-to-face consultation and hybrid care modality over intervention period-1. Patients were primarily middle-aged females (90.1%), with (median, IQR) 12 (9-16) years of education, long-standing disease, working (62.8%), receiving disease-modifying anti-rheumatic drugs (96.7%), and corticosteroids (61.2%). Patients had low disease activity (median Routine Assessment of Patient Index Data 3: 2.7) and Health Assessment Questionnaire Disability Index score that translated into the absence of disability, while quality of life was compromised. Baseline characteristics were similar between patients assigned to each healthcare intervention. Differences in Routine Assessment of Patient Index Data 3 behavior were below the non-inferiority margin. Results considered the order in which patients received the intervention and baselines scores, and extended to the patient-reported outcomes left. Hybrid care modality was non-inferior to in-person consultations in achieving patient-reported outcomes during the COVID-19 pandemic in rheumatoid arthritis patients.

The relationship between hydroxychloroquine plasma concentration and COVID-19 outcomes in rheumatoid arthritis patients in Saudi Arabia

BackgroundThe drug hydroxychloroquine (HCQ) is widely used to treat rheumatoid arthritis (RA) and has been repurposed for the treatment of COVID-19. This study aims to determine whether HCQ concentration levels in individuals with RA alter the incidence of COVID-19 or its complications. MethodsWe collected plasma samples from 13 individuals with confirmed rheumatoid arthritis (RA) to measure HCQ concentration levels. The study included individuals at least 18 years old who had been taking HCQ for at least six months at daily doses ranging from 200 to 400 mg. ResultsThe study enrolled a total of 13 RA patients. All patients were chronic HCQ users. Among the 13 patients, 7 patients were receiving HCQ at a dose of 200 mg per day, and 6 patients were receiving HCQ at a dose of 400 mg per day. COVID-19 confirmed cases accounted for approximately 46% of all patients. Half of the infected patients (n = 3) were taking a daily dose of 200 mg daily, while the other half were taking 400 mg daily. COVID-19 symptoms ranged from mild to moderate, and the intensity of the symptoms was not severe enough to necessitate hospitalization. COVID-19 symptoms in RA patients included headache, fever, fatigue, dry cough, and loss of taste or smell. ConclusionsOur findings indicated that there was no correlation between HCQ concentrations in rheumatoid arthritis patients and the occurrence of COVID-19 or its complications.

Ability of α – II Spectrin Breakdown Products and Septin 5 as Predictors for Severity and Clinical Outcome in Rheumatoid Arthritis Patients

There is a continuous interesting in finding new biomarkers that can be used as diagnostic tools for severity of rheumatoid arthritis (RA). Septin-5, a protein that indirectly inhibit neurotransmitter release, Alpha-2 spectrin breakdown products 145 (SBDP145), a protein that increased in neuronal damage, and vitamin D (VitD) are measured in the sera of 120 RA patients and 60 healthy controls (HC). The results showed an increase in SBDP145 level and a decrease in the VitD and calcium levels in RA group compared to HC. While no significant difference in septin-5 and magnesium between the groups. The receiver operating characteristics study showed that VitD has a good sensitivity and specificity for differentiating RA from HC. While Septin-5 and SBDP145 have no significant sensitivity and specificity. There is an increase in the serum levels of erythrocyte sedimentation rate (ESR) and anticyclic citrullinated protein antibody (ACCPA) in RA patients compared with the control group. Also, there are high ratios of RA patients with positive results of C-reactive protein (CRP) and rheumatoid factor (RF). It can be concluded that RA patients are suffering from hypovitaminosis D and hypocalcemia.

P090 Clinical prediction models for methotrexate treatment outcomes in rheumatoid arthritis patients: a review of existing models and summary of their limitations

Abstract Background/Aims Methotrexate (MTX) is the preferred first line therapy for rheumatoid arthritis (RA), according to NICE guidelines. MTX has several advantages over other treatments including effectiveness and low cost; however, around 40% of patients are classed as non-responders after 6 months. Therefore, there is a clinical need to identify patients at high-risk of poor outcomes, such that patients could potentially be fast tracked onto alternative therapies to improve their clinical outcomes and quality of life. Such risk stratification is possible through prognostic prediction models, although models which have previously been developed appear to have had little impact on practice. This may be in part due to methodological features of their development and validation but, to date, no review has collated the evidence in this field. This review therefore aimed to (i) identify and summarise multivariable prediction models of MTX treatment outcomes in biologic-naïve adult RA patients, and (ii) appraise their methodological properties. Methods A systematic search was carried out using Medline Ovid to identify studies developing or validating prediction models of MTX outcomes in the population of interest, including demographic, disease-specific or treatment-related covariates, published between 2005 and 2020. Models were stratified by outcome definition, and information on predictors, predictor associations with the outcome, model performance, handling of missing data and model validation were extracted. Results Twenty-two studies (14 (64%) using data from observational studies and 8 (36%) from randomised controlled trials) were identified. Of these, 15 (68%) based their outcome on a state of disease activity, such as low disease activity or remission, 4 (18%) used the EULAR response criteria, and 3 (14%) predicted discontinuation due to adverse events (AEs). AEs were also incorporated into the composite outcome with disease activity in 3 (14%) studies, 1 (5%) investigated both outcomes in separate models, and only 1 (5%) accounted for potential competing risks to their primary outcome. Internal validation using cross sampling techniques, which is critical for reducing overfitting, was completed in only 5 (23%) studies. Only 4 (18%) studies carried out external validation in new data. Missing data was appropriately handled using multiple imputation in 5 (23%) studies, whilst others used single imputation (n = 1, 4%) or complete case analysis (n = 13, 59%), resulting in potentially biased risk estimates, or did not report how they handled missing data (n = 3, 14%). Conclusion This review summarises current prediction models of MTX treatment outcomes in RA. It highlights several methodological shortcomings that should be addressed in future model development and validation to improve accuracy of predictions. Without tackling these issues, prediction of MTX treatment outcomes will remain at high risk of bias and should not be recommended for informing risk stratification for RA treatment decisions. Disclosure C. Gehringer: None. G. Martin: None. K. Hyrich: None. S. Verstappen: None. J. Sergeant: None.

Exploring drug cost and disease outcome in rheumatoid arthritis patients treated with biologic and targeted synthetic DMARDs in Norway in 2010\u20132019 \u2013 a country with a national tender system for prescription of costly drugs

BackgroundIn Norway, an annual tender system for the prescription of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) has been used since 2007. This study aimed to explore annual b/tsDMARDs costs and disease outcomes in Norwegian rheumatoid arthritis (RA) patients between 2010 and 2019 under the influence of the tender system.MethodsRA patients monitored in ordinary clinical practice were recruited from 10 Norwegian centers. Data files from each center for each year were collected to explore demographics, disease outcomes, and the prescribed treatment. The cost of b/tsDMARDs was calculated based on the drug price given in the annual tender process.ResultsThe number of registered RA patients increased from 4909 in 2010 to 9335 in 2019. The percentage of patients receiving a b/tsDMARD was 39% in 2010 and 45% in 2019. The proportion of b/tsDMARDs treated patients achieving DAS28 remission increased from 42 to 67%. The estimated mean annual cost to treat a patient on b/tsDMARDs fell by 47%, from 13.1 thousand euros (EUR) in 2010 to 6.9 thousand EUR in 2019. The mean annual cost to treat b/tsDMARDs naïve patients was reduced by 75% (13.0 thousand EUR in 2010 and 3.2 thousand EUR in 2019).ConclusionsIn the period 2010–2019, b/tsDMARD treatment costs for Norwegian RA patients were significantly reduced, whereas DAS28 remission rates increased. Our data may indicate that the health authorities’ intention to reduce treatment costs by implementing a tender system has been successful.

PMS2 Patient-Reported Outcomes in Rheumatoid Arthritis Patients Treated with Tofacitinib or Biological Dmards in Real Life Conditions: Colombian and Peru Perspective

To describe the efficacy, safety and patient-reported outcomes (PROs) in patients with naïve rheumatoid arthritis (RA) treated with tofacitinib or biological DMARDs (bDMARDs) in real-life conditions. Non-interventional study performed between Mar’2017 and Sep’2019 in 13 sites from Colombia and Peru. Convenience and randomized sampling were performed for tofacitinib and bDMARDs, respectively. Demographic and clinical information was collected. Outcomes measured at baseline and 6-month follow-up were: Disease activity (RAPID3 [Routine Assessment of Patients Index Data]); Functional status (HAQ-DI [Health Assessment Questionnaire]); Quality of life (EQ-5D-3L [EuroQol Questionnaire]). Disease Activity Score-28 (DAS28) and frequency of Adverse Events (AE) were also reported. Unadjusted and adjusted differences from baseline were estimated and expressed in Least Square Mean Difference (LMD). Data from 100 patients treated with tofacitinib and 70 patients with bDMARDs was collected. At baseline, patients’ mean age was 53.53 years (SD 13.77), mean disease duration was 6.31 years (SD 7.01) and mean DAS28 was 5.48 (SD 2.97). Significant difference was found in following baseline characteristics: previous methotrexate, complementary access mechanism, time-to-supply (higher in the tofacitinib group), prednisolone treatment and concomitant use of leflunomide (greater in the bDMARDs group). Change from baseline at month-6 was not statistical different in the adjusted LMD [SE] for tofacitinib vs. bDMARDs for RAPID 3 (-0.20 [0.69] vs. -0.32 [0.71]), HAQ-DI (-0.56 [0.07] vs. -0.50 [0.08]), EQ-5D-3L (0.23 [0.06] vs. 0.29 [0.06]) and DAS28 (-3.86 [0.59] vs. -4.23 [0.61]). Patients from both groups presented a similar proportion of non-serious AE; two serious AE (2.00%) were reported in the tofacitinib group. Serious AE were not related to the treatment. These results have the non-interventional studies specific limitations. Change from baseline was not statistically different between tofacitinib and bDMARDs for RAPID3 and the secondary outcomes (HAQ-DI, EQ-5D-3L and DAS28). Patients from both groups presented a similar proportion of non-serious AE.

Longterm outcomes of rheumatoid arthritis patients with severe osteoporosis treated with either Teriparatide or antiresorptive treatment – an observational study

Longterm outcomes of rheumatoid arthritis patients with severe osteoporosis treated with either Teriparatide or antiresorptive treatment – an observational study

Outcomes in rheumatoid arthritis patients treated with abatacept: a UK multi-centre observational study

BackgroundRheumatoid arthritis (RA) is an inflammatory autoimmune disease that causes chronic synovitis, resulting in progressive joint destruction and functional disability and affects approximately 400,000 people in the UK. This real-world study aimed to describe the characteristics, treatment patterns and clinical outcomes of patients who received abatacept in UK clinical practice.MethodsThis was a multi-centre, retrospective, observational study of patients with RA treated with abatacept at four UK centres between 01 January 2013 and 31 December 2017. Data were collected from medical records of each patient from the index date (date of first bDMARD initiation) until the most recent visit, death or end of study (31 December 2017).ResultsIn total, 213 patients were included in the study. Patients received up to eight lines of therapy (LOTs). Treatment with abatacept, or any other bDMARD, was associated with reductions in DAS28-ESR and DAS28-CRP scores at 6 and 12 months. The distribution of EULAR responses (good/moderate/no response) tended to be more favourable for patients when receiving abatacept than when receiving other bDMARDs (22.8%/41.3%/35.9% versus 16.6%/41.4%/42.1% at 6 months, and 27.9%/36.1%/36.1% versus 21.2%/34.5%/44.2% at 12 months). Patients receiving abatacept at LOT1 (n = 68) spent significantly longer on treatment compared with patients receiving other bDMARDs (53.4 vs. 17.4 months; p< 0.01); a similar trend was observed for LOT2. Among patients who discontinued after 6 months, a greater proportion experienced infection requiring antibiotics when receiving other bDMARDs compared to those receiving abatacept.ConclusionsRA patients who received bDMARDs, including abatacept, experienced reduced disease activity. When receiving abatacept as first or second line of therapy, patients persisted with treatment significantly longer than those receiving other bDMARDs.

Exploring Drug Cost and Disease Outcome in Rheumatoid Arthritis Patients Treated With Biologic and Targeted Synthetic DMARDs in Norway from 2010 to 2019 – A Country With a National Tender System for Prescription of Costly Drugs

Exploring Drug Cost and Disease Outcome in Rheumatoid Arthritis Patients Treated With Biologic and Targeted Synthetic DMARDs in Norway from 2010 to 2019 – A Country With a National Tender System for Prescription of Costly Drugs

Effects of overweight and underweight on the treatment outcomes of rheumatoid arthritis patients treated with biological drugs: A retrospective observational descriptive study.

The effects of the body size condition (overweight and underweight) on the outcome of antirheumatic drugs are unclear. The aim of this study was to elucidate the relationship between body size and treatment outcomes in rheumatoid arthritis patients treated with biological antirheumatic drugs. A retrospective observational descriptive study was conducted at Tokyo Women's Medical University, Medical Center East, from June 2015 to May 2018. Primary and secondary outcomes were defined as antirheumatic treatment ineffectiveness and antirheumatic treatment discontinuation due to any side effects, respectively. Multivariate logistic regression analysis was used to determine the risk factors for the outcomes and to calculate the odds ratio (OR) and the 95% confidence interval (95% CI). A total of 297 patients were included. Primary and secondary outcomes were observed in 42 (14%) and 11 (4%) of the patients, respectively. Multivariate logistic regression analysis demonstrated that a body mass index (BMI) ≥25kg/m2 (OR=4.22, 95% CI; 1.69-10.5, P=.002) was associated with rheumatoid arthritis treatment ineffectiveness and that BMI<18.5kg/m2 (OR=5.87, 95% CI; 1.25-27.5, P=.025) and tacrolimus use (OR=9.06, 95% CI; 1.37-60.1, P=.022) were associated with antirheumatic treatment discontinuation due to any side effects. The cut-off dose for tacrolimus was 0.5mg/day. Overweight affects antirheumatic drug efficacy. Underweight and tacrolimus use increased the discontinuation of antirheumatic drugs due to side effects. A validation study is needed to confirm the reliability of these results.

P214 Preliminary results: driving improvements in disease outcomes for rheumatoid arthritis patients using remote disease activity monitoring via smartphone app

Abstract Background Biologic dose tapering in RA is attractive due to the reduced costs, and potentially reduced risks, although there is a significant risk of disease flare. Capturing flares can be challenging within current NHS clinic frameworks with limited capacity. Remote disease monitoring through patient collected joint counts has previously been demonstrated to be feasible and reliable. BioT-app was co-designed by clinicians and patients using an iterative collaborative design process. It functions as a medication tracker and to remotely collect patient recorded joint counts. The aim of this study was to establish the validity, acceptability, and feasibility of BioT-app as a monitoring tool to support biologic dose tapering for RA patients. Methods 30 RA patients on injectable biologics were recruited to a prospective, observational study and followed for 6 months. Those enrolled in the app attended for joint count training, with a second remote assessment 1 week later to confirm patient reproducibility. Patients submitted tender &amp; swollen joint counts, and global VAS scores in line with their biologic dosing schedule. DAS28 scores were completed following entry of ESR/CRP levels. Patients observed to be in persistent low disease activity (DAS&amp;lt;3.3 for &amp;gt;6/12) were offered the opportunity to taper their biologic. Significant flares in DAS28 (&amp;gt;1.2 or any score &amp;gt;5.1) triggered contact by the clinical team and early face to face review offered. Results Thirty patients were enrolled into the study. One patient was withdrawn due to inability to submit their initial test-tracking DAS score. The mean age was 56.7 years (range 28-81), 56.7% were female; 86.7% were sero-positive (ACPA and/or RF). Ethnicity was 60% White British: 27% South Asian &amp; 13% White Other. Twenty patients (69%) were on TNFi (8 etanercept; 6 certolizumab; 3 adalimumab; 3 golimumab), and nine (31%) were on a non-TNFi biologic (6 tocilizumab; 3 abatacept). 48% of patients were on a weekly schedule, so submitted DAS scores weekly; 35% fortnightly; 17% monthly. Mean baseline DAS score was 2.43, mean initial patient submitted DAS was 3.09. One patient underwent re-training based on their initial self-submitted DAS. 12/31 (41%) of patients completed every DAS score; 8/31 (28%) completed &amp;gt;80% scores; 5/31 &amp;gt;60%. Four patients (13.8%) input less than 50% of their scores. Four patients’ biologics were tapered. Two patients flared, defined by DAS-28 increase &amp;gt;0.6 within 3 weeks, and returned to their baseline regimen. Two patients remained on a tapering regimen. One patient was switched back to bio-originator following submission of a DAS&amp;gt;5.1, confirmed by physician joint count during face-to-face consultation. Conclusion Preliminary results suggest that BioT-App is a reliable and acceptable tool which facilitates enhanced remote monitoring and rapid response to changes in disease activity scores for patients on biologic therapy, including those undergoing dose tapering. Disclosures A.C.B. MacBrayne None. J. Pott None. V. Petrovic None. C. Pitzalis None. F. Humby None.

Evaluation of Rheumatoid Arthritis Outcome Measures between Users and Non-Users of the Patient Portal

IntroductionPatient engagement has become a growing focus in healthcare, catalyzed with the passage of the HITECH Act in 2009.&nbsp; Stage 2 of Meaningful Use has criteria dependent on a patient portal, however whether electronic patient engagement translates into better clinical outcomes is yet to be determined.&nbsp; To begin an evaluation into this we reviewed outcomes in rheumatoid arthritis patients who had signed up for the patient portal compared to those who did not. MethodsData was obtained from a retrospective chart review of rheumatoid patients seen at the Ohio State University Rheumatology Clinics.&nbsp; Outcome measures including the most recent sedimentation rate (ESR), Rapid 3, and swollen joint count were evaluated.&nbsp; Two tailed t tests for these outcomes were done between each the group who had signed up for the patient portal and those that did not. Results132 patients were included with 66 having signed up for the patient portal (Users) and 66 not signed up for the patient portal (Non-users).&nbsp; 103 (78.0%) of patients were female, with a mean age of 55 ±13.79 years.&nbsp; Outcome measures between the patients who signed up for the patient portal compared to those who had not 14.77 ±7.57 compared to 13.48 ±7.73 (p=0.33) for Rapid 3 scores, 1.97 ±2.25 compared to 2.86 ±4.06 (p=0.16) for swollen joint count, and 39.88 ±29.76 mm/hour compared to 30.61 ±22.04 mm/hour (p=0.04) for ESR. ConclusionsThis initial study cohort does not demonstrate any clinically significant difference in several key outcome measures in rheumatoid arthritis, particularly Rapid 3 scores and swollen joint counts.&nbsp; However there was a statistical difference between the ESR, with more favorable values in patients using the patient portal.&nbsp; This data suggests further study is needed to better understand if electronic patient engagement does have an effect on clinical outcomes in RA.

Association between ABCB1 C3435T polymorphism and methotrexate treatment outcomes in rheumatoid arthritis patients: a meta-analysis.

Aim: This study was conducted to investigate the relationship between ABCB1 gene C3435T polymorphism and methotrexate treatment outcomes in rheumatoid arthritis patients. Methods: Seven electronic databases (PubMed, EMBASE, Web of Science, Cochrane, OVID, Chinese biomedical literature [CBM], China National Knowledge Infrastructure [CNKI] and Wanfang databases) were searched to select eligible publications until 18 July 2018. The references of relevant articles were also manually searched. The quality evaluation of the included studies was carried out according to the guidelines of the Newcastle-Ottawa Scale. Data were analyzed with Review Manager 5.3 and Stata 13.0 software. In total, 12 articles involving 2014 patients were included. Conclusion: Our results demonstrated that the ABCB1 gene C3435T polymorphism might be a reliable predictor of response to methotrexate in rheumatoid arthritis patients. However, well-designed, multicenter and large-scale prospective studies are required to further confirm the validity of our results.

Infliximab dose adjustment can improve the clinical and radiographic outcomes of rheumatoid arthritis patients: REVIVE study results.

PurposeWe evaluated the clinical responses and radiographic outcomes of 90 patients with rheumatoid arthritis (RA) undergoing continuous or dose-adjusted infliximab treatment over 104 weeks.Patients and methodsPatients received 3 mg/kg infliximab continuously (the contin group; n=50), or the dose escalation and de-escalation of infliximab (3, 6, and 10 mg/kg) from week 14 (the adjusted group; n=40) based on the patient’s Disease Activity Score in 28 joints (DAS28). The retention rate, clinical response, and radiographic assessment were determined at week 104.ResultsThe contin and adjusted groups’ retention rates at week 104 were 56.8 and 66.7%, and the groups’ low disease activity in the DAS28 was 39.1 and 66.7%, respectively. Remission based on the DAS28 and the American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) Boolean-based criteria was significantly increased in the adjusted group. In the radiographic assessment, there was also a significant reduction in the mean changes in total Sharp score. The cumulative rates of any adverse effects showed no significant difference between the groups.ConclusionIn an assessment of adequate DAS28 results, the RA patients who did not respond to the initial dose of infliximab showed improved clinical responses and radiographic assessment after a dose adjustment of infliximab, without an increased risk of serious adverse events.

Porphyromonas gingivalis in the tongue biofilm is associated with clinical outcome in rheumatoid arthritis patients.

Several studies have suggested a link between human microbiome and rheumatoid arthritis (RA) development. Porphyromonas gingivalis seems involved in RA initiation and progression, as supported by the high occurrence of periodontitis. In this case-control study, we analysed tongue P. gingivalis presence and quantification in a large healthy and RA cohort. We enrolled 143 RA patients [male/female (M/F) 32/111, mean ± standard deviation (s.d.), age 57·5 ± 19·8 years, mean ± s.d. disease duration 155·9 ± 114·7 months); 36 periodontitis patients (M/F 11/25, mean ± s.d., age 56 ± 9·9 years, mean ± s.d. disease duration 25·5 ± 20·9 months); and 57 patients (M/F 12/45, mean ± s.d., age 61·4 ± 10·9 years, mean ± s.d. disease duration 62·3 ± 66·9 months) with knee osteoarthritis or fibromyalgia. All subjects underwent a standard cytological swab to identify the rate of P. gingivalis/total bacteria by using quantitative real-time polymerase chain reaction. The prevalence of P. gingivalis resulted similarly in RA and periodontitis patients (48·9 versus 52·7%, P = not significant). Moreover, the prevalence of this pathogen was significantly higher in RA and periodontitis patients in comparison with control subjects (P = 0·01 and P = 0·003, respectively). We found a significant correlation between P. gingivalis rate in total bacteria genomes and disease activity score in 28 joints (DAS28) (erythrocyte sedimentation rate) (r = 0·4, P = 0·01). RA patients in remission showed a significantly lower prevalence of P. gingivalis in comparison with non-remission (P = 0·02). We demonstrated a significant association between the percentage of P. gingivalis on the total tongue biofilm and RA disease activity (DAS28), suggesting that the oral cavity microbiological status could play a role in the pathogenic mechanisms of inflammation, leading to more active disease.