1. SAT0699
Rapid assessment predicts disease activity improvement in newly diagnosed Rheumatoid Arthritis (RA)
Mark Yates*, James Galloway, Neil Snowden, Sam Norton, Jo Ledingham, Elaine Dennison, Ali Rivett, Andrew Rutherford, Alexander Macgregor. Academic Rheumatology Dept, King’s College London, UK
Introduction
Early intervention in RA is associated with improved outcomes in randomised trials (1).
UK guidelines for review of suspected early inflammatory arthritis recommend that;
There are limited real world data confirming the value of early assessment.
Previous work suggests social deprivation predicts severe disease at presentation and a worse clinical course (2).
The impact of deprivation in early assessment has yet to be characterised on a national level. 
Figure 1.
Most deprived area
1st
32,844th
Least deprived area
The Index of Multiple Deprivation (IMD)
A ranking of each small area in England…
…Based on 7 domains
Results
A total of 5622 RA diagnosed patients recruited across England and Wales.
39.7% (n= 2234) provided DAS-28 baseline and follow up data.
16% (n=901) provided RAID baseline and follow up data.
Early rheumatology assessment associates with achieving a good EULAR response and MCID RAID.
Unit level variation is very high.
“People with suspected persistent synovitis are assessed in a rheumatology service within 3 weeks of referral”
Timely rheumatology assessment associates with:
A good EULAR DAS-28 response (adj OR 1.38 (CI ))
RAID improvement (adj OR 1.44 (CI ))
Discussion
Timely rheumatology review leads to improved outcomes, seen as early as 3 months.
Amongst those who were assessed within 3 weeks of referral, an additional 8% achieved a good EULAR DAS-28 response.
Those who are more deprived have a weaker association between early review and the patient reported RAID score.
Missing data are an issue. Imputation is proposed.
Methods
A prospective longitudinal observational study of early RA care in England and Wales.
Clinician and patient questionnaire at baseline and through to 3 months follow up.
Predictor variable: Rheumatology assessment within 3 weeks.
Outcome variables: EULAR DAS-28 good response, meaningful improvement in RAID score.
Confounders: IMD quintile (see figure 1), age, gender, smoking status, ethnicity.
Primary analysis is multivariate logistic regression.
Seen within 3 weeks
Not seen within 3 weeks
P Value N
878
1356
Age (SD)
58.6 (14.8)
59.9 (14.1)
0.046 *
Female %
65.2
64.4
0.24 **
White British % 86
88.9
0.015 **
Current smoker %
21.1
25.4
0.009 **
IMD quintile mean 3
DAS28 EULAR good response %
43.7
35.8
0.001 **
Achieved MCID† RAID % 48
40.7
0.026 *
*t-test **chi-squared †Minimal clinically important difference (reduction by 50% or absolute reduction >3)
Acknowledgements
Many thanks to The British Society for Rheumatology for funding this work, and all staff in the Academic Rheumatology Dept at King’s College London for support and advice.
RA Impact of disease (RAID) score
A patient reported outcome measure focussing on 7 domains: pain, functional disability, fatigue, sleep, physical wellbeing, emotional wellbeing, and coping.
References
Grigor C, Capell H, Stirling A, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004 Jul 17-23;364(9430):263-9.
ERAS Study Group. Socioeconomic deprivation and rheumatoid disease: What lessons for the health service? Ann rheum dis. 2000;59(10):794-9.