ALL-CAUSE MORTALITY IN EARLY RHEUMATOID ARTHRITIS PREDICTED BY HEALTH ASSESSMENT QUESTIONNAIRE AT ONE YEAR

Background: Patients with RA are at greater risk of mortality than the general population. Higher HAQ disability has been associated with hospitalizations and mortality in established RA; whether HAQ disability predicts mortality in early RA (ERA) is unknown. Objectives: The objective of this study is to analyze how well the HAQ can predict future mortality in patients with early RA. Methods: Data were from adult early RA patients (symptoms <1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) between 2007 and 2017; who initiated treatment with 1 or more DMARDs and had completed HAQ data at baseline and 1 year. Descriptive statistics, t-tests and chi-square tests were used to summarize and compare baseline patient characteristics including sociodemographic variables, RA characteristics and comorbidities amongst deceased and non-deceased patients. Discrete-time proportional hazards models were used to estimate crude and multi-adjusted associations between HAQ at baseline and 1 year, respectively, with all-cause mortality in each year of follow up. Results: This study included 1724 patients with early RA; mean age was 55 years and 72% were female. In 10 years of follow up, 62 deaths (2.4%) occurred. Deceased patients had higher HAQ scores and DAS28 scores at baseline and at 1 year versus the non-deceased group. Age, male sex, lower education, smoking, more comorbidities, higher baseline disease activity and steroid use were associated with mortality in unadjusted survival models ( Table 1 ). Contrary to HAQ at baseline, the association between all-cause mortality and HAQ at 1 year remained significant even after adjusting for age, gender, comorbidities, disease activity, smoking, education, seropositivity, symptom duration and steroid use in adjusted survival models ( Table 2 ). Table 1. Unadjusted survival model: Association of each variable with all-cause mortality Baseline Variable Unadjusted Hazard OR 95% CI Socio-Demographic Age (years) 1.10 1.07 – 1.13 Female 0.37 0.22 – 0.62 Caucasian (white or European) 1.01 0.46 – 2.24 Aboriginal 1.71 0.61 – 4.76 Education > high school degree 0.48 0.28 – 0.82 Current Smoker 1.81 1.01 – 3.24 Rheumatic Disease Comorbidity Index (0-9) 1.60 1.36 – 1.87 RA Characteristics Symptom duration (months) 0.99 0.91 – 1.08 Seropositivity in first year 1.11 0.55 – 2.23 DAS28 ESR or CRP if ESR is missing 1.26 1.06 – 1.51 Oral Steroid use 1.75 1.03 – 2.98 Table 2. Multivariable discrete-time survival models: HAQ baseline vs 1 year Model Model 1: Crude (Time + HAQ-DI) Model 2: Adjusted for age + sex Model 3: Adjusted for Model 2 + DAS28 + RDCI Model 4: Adjusted for Model 3 + education, smoking, seropositivity, symptom duration and oral steroids use Model 5: Adjusted for Model 3 + smoking, symptom duration only HAQ-DI (0-3) (at baseline) 1.46 1.02 – 2.09 1.37 0.96 – 1.95 1.25 0.81 – 1.94 1.32 0.85 – 2.04 1.30 0.84 – 2.00 HAQ-DI (0-3) (at 1 year) 2.58 1.78 – 3.72 2.40 1.63 – 3.52 1.75 1.10 – 2.77 1.87 1.16 – 3.02 1.73 1.09 – 2.74 *Hazard OR, 95% CI ~HAQ-DI: (Health Assessment Questionnaire Disability Index); RDCI: Rheumatic Disease Comorbidity Index; DAS28: Disease Activity Score Conclusion: Higher HAQ at 1 year was significantly associated with all-cause mortality in a large early RA cohort suggesting that poorer disease control and function in the first year of RA contributes to higher mortality. Disclosure of Interests: Safoora Fatima: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance) Amgen Canada (CATCH, clinical nurse) Abbvie (CATCH, clinical nurse) Pfizer (CATCH, Registry of biologics, Clinical nurse) Hoffman-LaRoche (CATCH) UCB Canada (CATCH, Clinical nurse) BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT) Janssen (CATCH) Celgene (Clinical nurse) Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Vivian Bykerk: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB Citation: Ann Rheum Dis, volume 79, supplement 1, year 2020, page 588Session: Rheumatoid arthritis - prognosis, predictors and outcome (Poster Presentations)