The feasibility of existing JADAS10 cut-off values in clinical practice: a study of data from The Finnish Rheumatology Quality Register

BACKGROUND

The ten-joint juvenile arthritis disease activity score (JADAS10) is designed to measure the level of disease activity in non-systemic juvenile idiopathic arthritis by providing a single numeric score. The clinical JADAS10 (cJADAS10) is a modification of the JADAS10 that excludes erythrocyte sedimentation rate (ESR). Three different sets of JADAS10/cJADAS10 cut-offs for disease activity states have been published, i.e., the Backström, Consolaro, and Trincianti cut-offs. The objective of this study was to investigate the performance of existing JADAS10 cut-offs in real-life settings using patient data from The Finnish Rheumatology Quality Register (FinRheuma).

METHODS

Data were collected from the FinRheuma register. The proportion of patients with an active joint count (AJC) above zero when classified as being in clinically inactive disease (CID) or low disease activity (LDA) groups according to existing JADAS10/cJADAS10 cut-off levels were analyzed.

RESULTS

A significantly larger proportion of the patients classified as being in CID had an AJC > 0 when using the JADAS10/cJADAS10 cut-offs by Trincianti et al. compared to those for the other cut-offs. In the LDA group, a significantly larger proportion of the polyarticular patients (35%/29%) had an AJC of two when Trincianti JADAS10/cJADAS10 cut-offs were used compared with when Backström (11%/10%) and Consolaro (7%/3%) JADAS10/cJADAS10 cut-offs were used.

CONCLUSIONS

We found the cut-offs proposed by Consolaro et al. to be the most feasible, since these cut-off levels for CID do not result in the misclassification of active disease as remission, and the proportion of patients with AJC > 1 in the LDA group is lowest using these cut-offs.

AB0164 ARE PATIENTS WITH RA IN REMISSION IN FINLAND DURING THE COVID TIMES? RESULTS FROM THE FINNISH QUALITY REGISTER

Background

Worries have been expressed, concerning the care of chronic diseases during the Covid times (1).

Objectives

To study the current status of patients with RA in the Finnish quality register database.

Methods

Patients who receive care for RA were identified in the database. Clinical and demographic data from the last visits during 2020-21 were collected, including swollen (SJC46) and tender joint counts (TJC46), doctor assessment of disease activity (Dr global), laboratory tests for inflammatory and serology markers, patient reported outcomes (PROs), and DAS28. Regression models were applied to compare measures of clinical status between the health care regions, adjusted for gender, age, ACPA status, and disease duration.

Results

A total of 14163 patients (72% female, mean (SD) age 62 (14) years, median (IQR) disease duration 8.5 (2.6, 20) years, 84% ACPA positive) were identified. For the entire population, the median (IQR) SJC46 was 0 (0, 1), TJC46 0 (0, 2), ESR 8 (5, 18), CRP 3 (1, 6), and dr global 8 (0, 19). Among PROs, median (IQR) HAQ was 0.5 (0, 1), pain 26 (10, 51), fatigue 28 (8, 54) and patient global 29 (11, 51). Between health care regions, statistically significant differences were found for all variables due to a large sample size. The mean (SD) DAS28 was 2.3 (0.9) for the entire group and 69 % of all patients had DAS28<2.6. The median DAS28 ranged from 2 to 2.7 among health care regions (Figure 1) (p<0.001). Majority of patients were taking csDMARDs only.

Figure 1.

Rheumatoid arthritis in 2020-21: The median DAS28-values in 19 regions in Finland.

Conclusion

The quality register provides comprehensive real-world data on the current status of patients with RA. A majority of patients can be considered being in remission even during the Covid times.

References

[1]Glintborg et al. Rheumatology (Oxford) 2021 Oct 9;60(SI):SI3-SI12

Acknowledgements

I would like to thank The Finnish Society for Rheumatology and The Finnish Psoriasis Association for their grants.

Disclosure of Interests

None declared

POS0335 IMPROVED PAIN COPING SCALE FOR CHILDREN AND THEIR CAREGIVERS

Background

Pain can be a problem in a subgroup of juvenile idiopathic arthritis (JIA) patients even though in clinical remission. This can at least partly be due to their pain coping strategy of catastrophizing [1]. In a chronic disease such as JIA, the quality of coping with pain is crucial. The importance of coping with pain is well recognized in children [2]. The understanding of the parental role in supporting the child in pain is growing [3]; yet measuring the precise mechanism of parental pain coping is less studied. Thus, it seems important to measure also parental coping quality.

Objectives

The aim of this study was to develop a pain coping scale (PCSpar) for assessing the parents’ coping strategies to their child´s pain and a shorter improved PCSped for children feasible for use in clinical practice.

Methods

The original pain coping questionnaire (PCQ) [4] has been validated in Finnish [5] resulting in a 38-item, eight-factor structured PCQ. The items in the new version of PCQ were reduced into twenty by an interdisciplinary team (mPCQped). A corresponding scale was created for parental use (mPCQpar). Consecutive patients aged 8-16 years, visiting pediatric rheumatology outpatient clinic, reporting musculoskeletal pain during the last week before visit or longer, were recruited to participate in this study. Both the patient and the caregiver rated the child’s pain VAS from 0 to 100, completed the mPCQped /the mPCQpar and Children´s Depression Inventory (CDI) [6]/the Beck´s depression Inventory (BDI) [7] as appropriate. The selection process of pain questionnaire items was performed with factor analyses. The construct validity, the associations of the mPCQ factors, CDI, BDI and pain VAS, were tested by Spearman´s correlation coefficient.

Results

The study was conducted in all five tertiary and four secondary hospitals evenly distributed throughout Finland. Of the 153 families invited to the study, 130 attended. The average (SD) age of the attending patients was 13.0 (2.3) years. Of the patients, 91 (70%) were girls. Several steps in the exploratory factor analyses preceded the final factor analyses mPCQped and mPCQpar results. The four factors retained in the new improved Pain Coping Scale for children (iPCSped) were named positive cognitive distraction, catastrophizing (CATped), seeking social support (SSSped) and behavioral distraction. The factors in the improved Pain Coping Scale for caregivers (iPCSpar) were positive self-statement, catastrophizing (CATpar), seeking social support and distraction. In both iPCSped and iPCSpar there are a total of 15 items, 2-5 items/factor. The factor´s Cronbach´s alpha reliability coefficients were satisfactory, and the goodness-of-fit statistics were good. The CATpar correlated to BDI Rs= 0.33, p<0.05 and parent’s assessment of the child’s pain Rs= 0.23, p<0.05 in caregivers. The CATped correlated to CDI Rs= 0.49, p<0.05 and SSSped Rs= 0.26, p=0.05 but not to patient pain VAS Rs= 0.08, p>0.05.

Conclusion

In this study, we created a shorter pain coping scale for children (iPCSped) and a novel scale for caregivers (iPCSpar). Both showed good validity and reliability.

References

[1]Lomholt JJ et al. Pediatric Rheumatology 2013;11:21-28.

[2]Gaultney, AC et al. Children 2017;4:11.

[3]Caes L et al. Front. Psychol 12:680546. doi: 10.3389/fpsyg.2021.680546

[4]Reid GJ et al. Pain 1998;76:83-96.

[5]Marttinen MK et al. Eur J Pain 2018;22:1016-1025.

[6]Kovacs M et al. Psychopharmacil Bull 1985;21:995-8.

[7]Beck AT et al. Arch Gen Psychiatry 1961;4:561–71.

Disclosure of Interests

None declared

AB0168 DISEASE BURDEN MEASURED BY PROs: DOES PSORIATIC ARTHRITIS (PsA) FEEL WORSE THAN RHEUMATOID ARTHRITIS (RA)? A CROSS-SECTIONAL STUDY

Background

Little comparative research has been done comparing disease burden between PsA and RA. Previous studies from Nordic countries and the US have shown small differences (0-10/100 VAS units) in patients with PsA vs. RA. The mean and median VAS levels for PsA and RA ranged between 30-40 for pain and 40-50 for fatigue and patient global health in cross-sectional settings (1, 2, 3).

Objectives

To study the current differences in PROs between PsA and RA in Finland.

Methods

3731 patients receiving care for PsA and 14163 for RA were identified in the national quality register for inflammatory arthritides in 2020-21. Patients were divided into groups by sex and age; <50 years, 50-60 years, 60-70 years and ≥70 years. The VAS values of pain, fatigue and patient global health at the most recent visit were compared in PsA vs. RA between the groups. Descriptive statistics and regression models were used for comparison.

Results

Patients with PsA vs RA were younger (mean (sd) age 54(14) vs 62(14)) and less often women (51% vs. 72%). Median (IQR) disease duration after the first symptoms was 8.6 (3.7, 17) years for PsA and 9.5 (3.3, 21) years for RA. The median (IQR) pain was 29 (10, 56) for all patients with PsA and 26 (10,51) for patients with RA. The corresponding values were: fatigue 28 (9, 60) in PsA vs 28 (8, 54) in RA, and patient global health 28 (10, 51) in PsA and 29 (11, 51) in RA.

Median pain was slightly higher in female PsA patients compared to RA patients in all age groups (29 and 18, 35 and 28, 32 and 27 and 48 and 38) (p<0.001). In males, higher levels of pain in PsA vs. RA were seen in age groups older than 50 years old. Figure 1 illustrates the mean (95% CI) pain for PsA and RA in the age and sex groups.

Median fatigue levels were quite similar between the groups. The median patient global health was higher in female PsA compared to RA patients in age groups <50 years and 50-60 years (20 vs. 29 and 30 vs 37) (p<0.001).

Figure 1.

Mean (95 % CI) pain in VAS-units for women and men by age groups in 2020-2021

Conclusion

Female patients with PsA report higher levels of pain in all age groups compared to patients with RA. The same was seen in men >50 years old. Concerning fatigue and patient global health, the differences between PsA and RA were smaller. Compared to earlier research in other countries, disease burden observed by PROs appears lower both in PsA and RA in Finland.

References

[1]Pilgaard T et al. Severity of fatigue in people with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis – Results of a cross-sectional study, PLoS One, 2019; 14(6): e0218831

[2]Egholm CL et al. Discordance of Global Assessments by Patient and Physician Is Higher in Female than in Male Patients Regardless of the Physician’s Sex: Data on Patients with Rheumatoid Arthritis, Axial Spondyloarthritis, and Psoriatic Arthritis from the DANBIO Registry, The Journal of rheumatology, 2015 Oct;42(10):1781-5.

[3]Mease PJ et al. Comparative Disease Burden in Patients with Rheumatoid Arthritis, Psoriatic Arthritis, or Axial Spondyloarthritis: Data from Two Corrona Registries, Rheumatology and therapy, 2019 Dec;6(4):529-542

Acknowledgements

I would like to thank The Finnish Society for Rheumatology and The Finnish Psoriasis Association for their grants.

Disclosure of Interests

None declared

SAT0488 ETANERCEPT CONCENTRATION IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background:

Etanercept (ETN) is the most used TNF blocker in children with JIA. There is still limited real-life data of etanercept concentrations in children, especially in association with dosing.

Objectives:

The aim of the study was to investigate association between ETN dosing and serum trough concentration in children with non-systemic JIA.

Methods:

We conducted a multicenter retrospective study of 180 Finnish JIA patients (Table 1) receiving ETN either as monotherapy or in combination with one or more DMARDs (Table 2). Prior biologicals were used by 17 % of the patients. Patients were divided into two groups, ETN started before or after one year of diagnosis (Figure 1). ETN concentration samples (collected 2014-2017) were analyzed using validated enzyme-linked immunosorbent assay (ELISA) in Sanquin Diagnostics, Amsterdam, the Netherlands.

Results:

Demographics at etanercept start and diagnoses are shown in Table 1. Duration of the treatment with ETN, ETN doses, concentrations and concomitant medications at the time of concentration measurement are shown in Table 2.

Association between ETN dose and concentration is shown in Figure 1.

Those who started medication early (< 1 year from diagnosis) were younger than those who started later (Table 1) and association between ETN dose and concentration was more obvious (Figure 1).

Conclusion:

There was an association between etanercept dose used and serum trough concentration and it was more evident when medication was started early after diagnosis, when the patients were younger and BSA lower.

References:

[1]Kneepkens EL et al. Lower etanercept levels are associated with high disease activity in ankylosing spondylitis patients at 24 weeks of follow-up. Ann Rheum Dis 2015;74(10):1825-9.

[2]Bader-Meunier B et al. Etanercept concentration and immunogenicity do not influence the response to Etanercept in patients with juvenile idiopathic arthritis. Semin Arthritis Rheum 2019;48(6):1014-1018.

Disclosure of Interests:

None declared