AB0305 Remaining foot synovitis may predict relapse in rheumatoid arthritis patients in das28 remission (DAS28-CRP<2.3)

Abstract

BackgroundDAS28 (Disease Activity Score based on 28 joints) is widely used to determine remission in rheumatoid arthritis (RA). The problems with DAS28 due to omission of the lower extremity joints have long been discussed. There are reports demonstrating that some patients meeting DAS28 remission criteria still have synovitis in their feet.1 It is suggested that patients with remaining foot synovitis can experience up to a 2-fold increase in relapse rates.2 Evidence supporting this hypothesis is still scarce.ObjectivesWe hypothesised that RA patients in remission according to the DAS28 remission criterion with remaining foot synovitis are less likely to stay in remission. We aimed to test this hypothesis among Japanese patients with RA.MethodsIn 2015, 15,071 RA patients were registered in a large nationwide database in Japan (NinJa). Among those patients, those who were in remission based on DAS28-CRP were included. We used DAS28-CRP<2.3 as the remission criteria. The study population was then divided into groups with or without tender/swollen joints in the feet. These patients were followed for one year and the remission rate was then calculated for each group. Comparison was performed with Chi-square test.ResultsWe included 706 RA patients in remission based on DAS28-CRP with foot synovitis in 2015 and 5182 without foot synovitis. Among patients with foot synovitis in 2015, 225 (31.9%) were not in remission in 2016 while among those without foot synovitis, 985 (19.0%) were not in remission. (X-squared=62.953, df=1, p=2.117 × 10–15)ConclusionsIn our study, RA patients in remission according to the DAS28 remission criterion with remaining foot synovitis had more relapses than those without it. Remission defined by DAS28-CRP does not take remaining foot synovitis into account. But a thorough foot examination may still be useful in RA patients with DAS28-CRP remission as they may be more at risk for relapse.References[1] van der Leeden, et al. Arthritis Res Ther. 2010;12,1:R3.[2] Wechalekar MD, et al. Arthritis Care Res. 2016;68,11:1616–1623.Disclosure of InterestNone declared