SP0160 DISEASE REMISSION: DO WE AIM FOR THE SAME THING?

It is consensually accepted that the most important therapeutic goals for treating rheumatoid arthritis (as well as other inflammatory arthritis) are eliminating signs and symptoms (such as joint pain, swelling, and stiffness); preventing joint damage or its progression; and maximizing physical function and quality of life (Aletaha & Smolen, 2019). According to current medical knowledge, these aims are believed to be best accomplished by achieving disease remission, a state in which no or only minimal residual inflammation is discernible (Aletaha & Smolen, 2019). However, different studies have been providing evidence that achieving inflammatory remission is not enough as a considerable proportion of patients with no or minimal inflammation remain with high levels of pain, fatigue, functional impairment, mental health problems, among other symptoms (Boone et al., 2019; Ferreira et al., 2019; Ferreira et al., 2017). The perfect path to achieve good results is still to be defined, namely, regarding the T2T strategy (van Vollenhoven, 2019). Recent studies still show that despite a high level of patient agreement with RA T2T, patient engagement in this process needs to be improved in order to individualize therapy adjustments, make shared decisions and decide on targets that accurately reflect disease control according to patients (Benham et al, 2019). In this session I would address the following questions: Is aiming for one target enough nowadays? Do health professionals and patients aim for the same thing when defining treatment strategies? Do the current treatment targets pose a risk of overtreatment with immunosuppressive therapy? This presentation is informed by current research in this area including research from our own group (Ferreira et al., 2018; Santos et al., 2018). References: [1] Aletaha, D., & Smolen, J. S. (2019). Achieving Clinical Remission for Patients With Rheumatoid Arthritis. JAMA, 321(5), 457-458. doi:10.1001/jama.2018.21249 [2] Benham, H., Rutherford, M., Kirby, S., Stebbings, S., White, D., Sim, D., & Harrison, A. (2019). Treat-to-target in rheumatoid arthritis: Evaluating the patient perspective using the Patient Opinion Real-Time Anonymous Liaison system: The RA T2T PORTAL study. International Journal of Rheumatic Diseases. doi:10.1111/1756-185x.13514 [3] Boone, N. W., Sepriano, A., van der Kuy, P. H., Janknegt, R., Peeters, R., & Landewe, R. B. M. (2019). Cotreatment with methotrexate in routine care patients with rheumatoid arthritis receiving biological treatment yields better outcomes over time. RMD Open, 5(1), e000836. doi:10.1136/rmdopen-2018-000836 [4] Ferreira, R. J. O., Carvalho, P. D., Ndosi, M., Duarte, C., Chopra, A., Murphy, E.,. . . da Silva, J. A. P. (2019). Impact of patient global assessment on achieving remission in patients with rheumatoid arthritis: a multinational study using the METEOR database. Arthritis Care Res (Hoboken). doi:10.1002/acr.23866 [5] Ferreira, R. J. O., Dougados, M., Kirwan, J., Duarte, C., de Wit, M., Soubrier, M.,. . . Gossec, L. (2017). Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: an analysis of 1588 patients Rheumatology. doi:10.1093/rheumatology/kex211 [6] Ferreira, R. J. O., Ndosi, M., de Wit, M., Santos, E. J. F., Duarte, C., Jacobs, J. W. G.,. . . da Silva, J. A. P. (2018). Dual target strategy: a proposal to mitigate the risk of overtreatment and enhance patient satisfaction in rheumatoid arthritis. Annals of the Rheumatic Diseases. doi:10.1136/annrheumdis-2018-214199 [7] Santos, E. J. F., Duarte, C., Ferreira, R. J. O., Pinto, A. M., Geenen, R., & da Silva, J. A. P. (2018). Determinants of happiness and quality of life in patients with rheumatoid arthritis: a structural equation modelling approach. Annals of the Rheumatic Diseases, 77(8), 1118-1124. doi:10.1136/annrheumdis-2017-212934 [8] van Vollenhoven, R. (2019). Treat-to-target in rheumatoid arthritis - are we there yet? Nature Reviews. Rheumatology, 15(3), 180-186. doi:10.1038/s41584-019-0170-5 Disclosure of Interests: None declared