POS0587 TRAJECTORIES AND FACTORS INFLUENCING THE EVOLUTION OF HAND GRIP AMONG PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

Background: Rheumatoid arthritis (RA) is characterized by an early reduced grip strength which persists over time despite the remission of the disease suggesting the presence of a sarcopenia. Objectives: To study the evolution of the grip strength measured by the handgrip. by identifying different trajectories and associated factors. Methods: Patients with active RA who visited the Rheumatology Department of Clermont-Ferrand University Hospital for initiating bDMARD were invited to participate to the longitudinal cohort RCVRIC analyzing cardiovascular risk and chronic infammatory rheumatic disease. Within the RCVRIC cohort 175 RA initially underwent a handgrip determination. 143 patients had at least 2 handgrip measurements over 2 years, allowing analysis of trajectories by the 'Group Based Trajectory Modeling' method. For the trajectories, handgrip was expressed in terms of percentage of the theoretical value defned according to age and sex. The clinical characteristics of the disease, the therapeutic response, and the body composition associated with each trajectory were analyzed. Results: At inclusion, the handgrip was normal among only 4% of patients, with an alteration of 51% of its theoretical value. After 2 years of follow-up, a majority of patients improved their handgrip trajectory to reach an average of 68% of the theoretical one, but only 15.7% of the patients normalized their handgrip. Four trajectories have been identified along with associated factors: 1st trajectory consists of low handgrip with little improvement and was composed of: 9 patients (6.3%), median age 60 years [53.6;69.3], 88% women, disease duration 17.99 years [6.78;24.9], DAS 28 ESR 4.68 ± 1.29, and initial handgrip 21% of the theoretical value [8;24]. 2nd trajectory shows good improvement (+72%) and was composed of: 70 patients (49%), median age 58.9 years [54.4;64.3], 84% women, disease duration 5.99 years [1.46;14.8], DAS 28 ESR 4.43 ± 1.07, and initial handgrip 32% of the theoretical value [17.8;46.4]. 3rd trajectory shows moderate improvement (+25%) and was composed of: 43 patients (30%), median aged 60.7 years [45.7;69.4], 79% women, disease duration 3.5 years [1.25;9.9], DAS 28 ESR 4.0 ± 1.03 and initial handgrip 60% of the theoretical value [48.2;76]. 4th trajectory shows high handgrip and was composed of: 21 patients (14.7%), 57% women, median age 57.9 years old [49.7; 67.4], disease duration 3.81 years [2.14; 10.7], DAS 28 ESR 3.68 ±1.29 and initial hand grip 92% of the theoretical value [85; 100]. Signifcant differences at inclusion between the 4 trajectories were observed. The 4th trajectory was characterized by a higher proportion of men (p=0.05), lower disease activity (DAS 28 ESR (p=0.02), SDAI (p=0.04)), better initial handgrip (p=0.03) and 6 min walk test (p=0.0001), and a lower percentage of fat mass (p=0.04). In contrast, a higher disability (HAQ, p=0.002), a lower total lean body mass (p=0.001) and poorer therapeutic response (p=0.04) were noted in trajectories 1 and 2. Conclusion: After 2 years of follow-up, a majority of patients improved their handgrip trajectory. However, very few patients normalized their hand grip. Four trajectories of handgrip were identified; the main indicators of hand grip's improvement were the control of the disease activity, low functional disability, walking performance, a low percentage of fat mass and high lean mass.