LAUSR

Background It has been demonstrated that biological DMARDs (bDMARDs) treatment rapidly improved sign and symptom in patients with rheumatoid arthritis (RA). Those were evaluated using composite measures or biomarkers in daily clinical practice or clinical studies. Although rapid improvement of composite measures or biomarkers is important in the treatment of RA, primary important goal of treatment is improvement of long term health-related quality of life (HR-QOL) [1]. HR-QOL is based on physical function such as muscle power and agility. Objectives This study investigated the efficacy of bDMARDs on physical function and fall risk in patients with RA. Methods Periodic evaluation of physical function by the staffs in rehabilitation center in our institute has been performed in addition to routine rheumatology evaluation (SDAI, biomarkers, mHAQ) in RA patient initiated their first bDMARDs treatment from Oct. 2015 to Feb. 2018. 47 cases was registered in total. Evaluation of physical function included evaluation of muscle power (grasping power [GP] and knee extension power [KEP]), agility (Time up and go test [TUG] and 10m walking time [10mW]) and questionnaire using mHAQ, portable fall risk index [2] and the 25-question geriatric locomotive function scale (locomo25) [3] at baseline (initiation of bDMARDs), 1month, 3months, 6months and 12months. Disease activity of RA (SDAI, CRPMMP-3) was evaluated at same time point. Although 26 cases have passed one year from initiation of bDMARDs treatment, 9 cases dropped out from evaluation of physical function due to stopping of bDMARDs treatment or patient’s hope not to e evaluated on physical function or major joint surgery performed in patient which was influence physical function. Results of early 17 cases who completed evaluation at 12 months were investigated in this study. Results Baseline patients characteristics was as follow (n=17): mean age 59.1 years old, RA duration 13.7 years, Mean SDAI 19.6, mean CRP 1.9mg/dl. Used bDMARDs were tocilizumab in 5 cases, golimumab in 4 cases, etanercept in 3 cases, abatacept in 3 case, certolizumab in one case and infliximab-biosimilar in one case. Date is presents as mean values at baseline-1-3-6-12 months below. SDAI and CRP were significantly improved on and after one month (SDAI: 19.6-9.6-5.8-5.7-5.5, CRP [mg/dl]: 1.9-0.3-0.3-0.3-0.8). GP and knee extension power significantly improved on and after one months except KEP at 3 months (GP [kg]: 12.3-14.1-15.9-16.9-17.4, KEP [N/kg] 2.6-3.1-3.1-3.4-3.5). TUG at 10mW significantly improved on and after one months except TUC at 3months and 10mW at 3 months (TUG [s]: 9.3-8.0-8.2-7.3-7.4, 10mW[s]: 8.3-7.7-7.5-6.9-6.8). MHAQ significantly improved on and from 6 months (0.46-0.33-0.19-0.20-0.12). Locomo25 significantly improved on and from 1 month (31.7-20.6-18.5-16.7-15.0). Portable fall risk index significantly improved at only 12 months (8.8-8.6-7.8-7.8-6.8). Conclusion Signs and symptoms of RA were rapidly improved after the initiation of bDMARDs treatment and improvement of physical function was also rapidly improved. The changes from baseline and one month were more drastic in composite measure or biomarker of inflammation than that in muscle power and agility in respect with p-values. Inhibition of fall were achieved 12 months after bDMARDs initiation. These results suggested that physiotherapy might play an important role in RA patients treated with bDMARDs to gain more rapid improvement of physical function. References [1] Smolen JS, et al. Ann Rheum Dis2016. [2] Toba K, et al. Jpn J Geriat2005. [3] Seichi A at al. J Orthop Sci2012. Disclosure of Interests None declared