OA39 The impact of achieving early remission for individuals with severe rheumatoid arthritis: a population-level cohort study in NEIAA

Abstract Background/Aims Previous studies have shown that high disease activity at diagnosis and seropositivity are markers of poor prognosis for individuals with early RA. In patients with these poor prognostic factors, prompt initiation and escalation of disease-modifying treatment is essential for achieving early remission and preventing morbidity. Our goal was to quantify the impact of achieving early remission on mental health outcomes, work disability, and healthcare utilisation in patients with RA who have poor prognostic factors at diagnosis. Methods We performed an observational cohort study of individuals with new RA diagnoses in England and Wales, enrolled in the National Early Inflammatory Autoimmune Diseases Audit (NEIAA) from May 2018 to April 2024, who had poor prognostic factors at diagnosis (defined as DAS28 5.1 and rheumatoid factor or CCP positive). Regression modelling was used to analyse the following outcomes, stratified by whether or not patients with poor prognostic factors achieved remission (DAS28 2.6) by 3 months: i) presence of depression or anxiety at 3 months; ii) cessation of employment by 3 months; iii) number of rheumatology outpatient appointments within 12 months; and iv) rate of all-cause hospitalisations within 12 months of diagnosis. Results Of 13,227 RA patients, 4,346 (32.9%) had poor prognostic factors at diagnosis. 23.3% of patients with poor prognostic factors achieved remission by 3 months, compared with 40.4% of patients without poor prognostic factors (odds ratio OR 0.45; 95% CI 0.41, 0.49; p 0.001). For patients with poor prognostic factors and available follow-up data, outcomes were significantly better for individuals who achieved early remission, relative to those not achieving remission: depression at 3 months (15.5% vs. 39.4%, respectively; OR 0.28; 95% CI 0.19, 0.42; p 0.001); anxiety at 3 months (11.2% vs. 30.2%; OR 0.29; 95% CI 0.19, 0.45; p 0.001); stopped working by 3 months (8.8% vs. 18.8%; OR 0.42; 95% CI 0.21, 0.81; p = 0.010); median number of rheumatology outpatient appointments within 12 months (6 vs. 7 appointments; beta-coefficient -1.00; 95% CI -1.43, -0.56; p 0.001); all-cause hospitalisation rate within 12 months (29.1 vs. 38.9 admissions per 100 person-years; hazard ratio 0.75; 95% CI 0.62, 0.91; p = 0.004). Conclusion In patients with RA who have poor prognostic factors at diagnosis, failure to achieve early remission associates with an increased burden of depression, anxiety, employment loss, and healthcare utilisation. Despite this, we showed that only 23% of RA patients with poor prognostic factors achieve early remission in current practice in England and Wales. This highlights an urgent need to identify patients with poor prognostic factors at diagnosis and ensure optimal care is provided. Disclosure M.D. Russell: Honoraria; AbbVie, Biogen, Galapagos, Johnson Sandoz UK. P. Lanyon: None. L. Kay: None. E. Alveyn: Other; Received support for attending meetings from UCB. C. Coalwood: None. S. Gallagher: None. E. Price: None. J.B. Galloway: Honoraria; Abbvie, Biovitrum, BMS, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB. Grants/research support; Sandoz UK.