FRI0097 EFFECTS OF BIOLOGICAL DISEASE-MODIFYING ANTI-RHEUMATIC DRUG TREATMENT ON PHYSICAL ACTIVITY, MUSCLE POWER, AGILITY AND INHIBITION OF FALL IN PATIENTS WITH RHEUMATOID ARTHRITIS -THE 2-YEAR RESULTS

Abstract

Background: Treatment with biological DMARDs (bDMARDs) rapidly improves signs and symptoms in patients with rheumatoid arthritis (RA). The efficacy of these bDMARDs was evaluated using composite measures or biomarkers used in daily clinical practice or clinical studies. Although a rapid improvement in composite measures or biomarkers is important in the treatment of RA, the primary goal of treatment is improvement of long-term health-related quality of life (HR-QOL) [1]. HR-QOL is evaluated based on physical functions (PF) such as muscle power and agility. We reported the 1-year results of our study presented at EULAR 2019 [2]. The present study was conducted to investigate the 2-year results of our study by including more patents than those included in the previous one. Objective(s): This study was aimed at investigating the efficacy of bDMARDs with respect to PF and fall risk in RA patients. Method(s): At our institute, in addition to routine rheumatology evaluation, periodic evaluation of physical function is performed by staff members in our rehabilitation center in RA patients in whom the first bDMARD treatment was initiated in Oct. 2015-Feb. 2018. In total, 41 cases were registered in this study. Evaluation of PF included evaluation of muscle power [grasping power (GP) and knee extension power (KEP)]; agility [time up and go test (TUG) and 10-m walking time (10 mW)]; and a questionnaire using modified HAQ, portable fall risk index [3], and the 25-question geriatric locomotive function scale (locomo25) [4] at baseline (BL), which implies the time at the initiation of bDMARD treatment, i.e., 1, 3, 6, 12, and 24 months. Disease activity of RA was evaluated at the same time points. Although 2 years had elapsed from BL in 37 patients, 13 patients dropped out from the evaluation of physical function owing to cessation of bDMARD treatment, rejection of evaluation for physical function, or major joint surgery performed in a patient. The results of 24 patients who completed the evaluation at 24 months were investigated in this study. Result(s): Baseline characteristics of the 24 patients were as follows: mean age 60.8 years, RA duration 12.3 years, mean SDAI 19.0, and mean CRP level 2.1 mg/ dl. The bDMARDs used in the study were abatacept in 7 patients, adalimumab in 4 patients, tocilizumab in 4 patients, golimumab in 4 patients, etanercept in 3 patients, certolizumab in 1 patient, and an infliximab biosimilar in 1 patients. Data are presented as mean values at BL and at 1, 3, 6, 12, and 24 months (Fig.1). SDAI and CRP levels were significantly improved at and after 1 month. GP and KEP were significantly improved at and after 3 and 6 months. TUG and 10 mW results were significantly improved at and after 3 and 6 months. Modified HAQ results were significantly improved at and after 3 months. Locomo25 scores were significantly improved at and after 1 month. Portable fall risk index values were significantly improved at and after 12 months Conclusion(s): Although there was a rapid improvement in the signs and symptoms of RA after the initiation of bDMARD treatment, improvement in PF was slightly delayed. Significant improvement of muscle power and agility was achieved after 3-6 months onward. Inhibition of fall risk was achieved at and after 12 months after the initiation of bDMARD treatment. These results suggest that physiotherapy plays a vital role in RA patients who undergo treatment with bDMARDs to gain more rapid improvement of PF.