POS0687 LONG TERM (10 YEAR) CLINICAL OUTCOME OF RECENT ONSET AXIAL SPONDYLOARTHRITIS (AXSPA): DATA FROM THE DESIR COHORT

Abstract

Background: The information related to the long term outcome of a disease is of huge interest for the clinicians in daily practice to facilitate the information of the patients recently diagnosed as axSpA. The data from inception cohorts are better approaching the truth of this long term prognosis in comparison to the conventional retrospective cohorts mainly conducted in patients with advanced and severe disease managed in tertiary referral centers. Objectives: To evaluate the 10 year clinical outcome (and its predisposing factors) of patients suffering from recent onset axSpA in the DESIR cohort. Methods: Study design: DESIR is an ongoing (10 year follow-up completed for all the patients) multicenter cohort of recent onset axSpA. Diagnosis: At entry visit and during the 10 year follow-up period, the diagnosis was based on the opinion of the treating physician with a requirement of a diagnosis of axSpA at entry and the possibility to exclude the patients after the first 2 years follow-up period in case of a change in this diagnosis. Management during the 10 year period: the investigators were in charge of the data collection required by the protocol but the management (treatment regimens) was only based on the decision of the treating rheumatologist. Statistical analysis: Data presented here are the ones issued a)from the analyses on the completers (observed data) and b) after multiple imputations considering the missing data due to the patients lost of follow-up (imputed data). Results: of the 708 enrolled patients, 45 were excluded from the cohort because of a change in the entry visit diagnosis, 3 patients died (suicide n = 1, colorectal cancer n = 1, sudden death n=1), 300 were lost of follow-up and 360 patients completed the 10 year period. A-Based on the analyses of the 10 year completers (n=360) No patient necessitated a spinal vertebrotomy, one single patient had a bilateral total hip replacement. A pension from the national health care system was provided to 16% patients because an invalidity related to the axSpA disease. A csDMARD (methotrexate and/or sulfasalazine) has been prescribed in 32% and a biotherapy in 55%. The prevalence of the main extra-musculoskeletal features increased from 18 to 30%, 10 to 18% and 5 to 10% from baseline to year 10 for psoriasis, acute anterior uveitis and inflammatory bowel disease respectively. The prevalence of the main comorbidities increased from 3 to 8%, 0 to 3%, 5 to 15%, 0 to 4%, 1 to 3% and 0 to 2%, from baseline to year 10 respectively for severe GI events, MACE, hypertension, diabetes, tuberculosis and other severe infections respectively. B-Based on the analyses of the 10 year completers (n=360) (observed data) and the 663 patients with unchanged initial axSpA diagnosis (imputed data) An acceptable status at year 10 was observed in 77%,70 [63; 77]%,;49% 43 [37; 49]%; 55% 48 [41; 56]% considering an acceptable PASS, BASDAI < 30, ASDAS < 2.1 for the observed (%) and imputed (% and [95%CI]) data respectively. The impact of the disease on the daily life of the patients was evaluated by different parameters: ASAS HI ≤ 5 (41 [35; 47]%, SF36 physical score (42 [40; 44]) and SF36 mental score (43 [40; 46]). The multivariate analysis of the baseline predisposing factors of an acceptable status at year 10 defined as an ASDAS score<2.1 picked-up the following variables: short (<1.5year)delay between the first symptoms and the baseline visit: OR= 1.46[0.93;2.29],socio-professional level (white collar): OR=1.87[1.20;2.90] and baseline BASDAI score<40, OR=1.91[1.23;2.94] Conclusion: These data are suggesting a favorable 10 year outcome in terms of stringent measures such as the requirement to surgery contrasting with a relatively less favorable outcome with regard to patient reported outcomes. These data should improve and facilitate the information provided to the patients at the time of their diagnosis.