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ObjectivesThis study aimed to evaluate different patient global assessment (PGA) cut-offs required in the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean remission definition for their utility in rheumatoid arthritis (RA).MethodsWe used data from six randomised controlled trials in early and established RA. We increased the threshold for the 0–10 score for PGA gradually from 1 to 3 in steps of 0.5 (Boolean1.5 to Boolean3.0) and omitted PGA completely (BooleanX) at 6 and 12 months. Agreement with the index-based (Simplified Disease Activity Index (SDAI)) remission definition was analysed using kappa, recursive partitioning (classification and regression tree (CART)) and receiver operating characteristics. The impact of achieving each definition on functional and radiographic outcomes after 1 year was explored.ResultsData from 1680 patients with early RA and 920 patients with established RA were included. The proportion of patients achieving Boolean remission increased with higher thresholds for PGA from 12.4% to 19.7% in early and 5.9% to 12.3% in established RA at 6 months. Best agreement with SDAI remission occurred at PGA cut-offs of 1.5 and 2.0, while agreement decreased with higher PGA (CART: optimal agreement at PGA≤1.6 cm; sensitivity of PGA≤1.5 95%). Changing PGA thresholds at 6 months did not affect radiographic progression at 12 months (mean ꙙsmTSS for Boolean, 1.5, 2.0, 2.5, 3.0, BooleanX: 0.35±5.4, 0.38±5.14, 0.41±5.1, 0.37±4.9, 0.34±4.9, 0.27±4.7). However, the proportion attaining HAQ≤0.5 was 90.2%, 87.9%, 85.2%, 81.1%, 80.7% and 73.1% for the respective Boolean definitions.ConclusionIncreasing the PGA cut-off to 1.5 cm would provide high consistency between Boolean with the index-based remission; the integer cut-off of 2.0 cm performed similarly.

The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) preliminary criteria for remission in rheumatoid arthritis (RA) have found widespread endorsement and adoption since their publication in 2011 (box 1).1 Patients that fulfil the criteria are almost indistinguishable from healthy persons and live a normal life.2 Nevertheless, the criteria are also seen as too strict,3 as not including enough patient-important outcomes4; and their application in patient care, as advised by guideline committees, has problems. Most of the criticism focuses on the inclusion of patient global assessment (PGA) and its threshold. Box 1 ### American College of Rheumatology–European League Against Rheumatism remission criteria.1 #### Boolean-based definition At any time point, patient must satisfy all of the following: Tender joint count ≤l* Swollen joint count ≤l* C reactive protein ≤1 mg/dL Patient global assessment (PGA) ≤1 (on a 0–10 scale)† #### Index-based definition At any time point, patient must have a Simplified Disease Activity Index Score of ≤3.3‡

Background:Balicitinib (BAR) is one of the Janus kinase (JAK) inhibitors, which mainly inhibits JAK1 and JAK2 and has an anti-inflammatory effect on rheumatoid arthritis(RA). In Japan, it is necessary to use different doses of BAR depending on the RA patient’s estimated glomerular filtration rate (eGFR). The RA-BEACOM and RA-BUILD trials reported the treatment effects by BAR dose at 24 weeks and concluded that there was no difference in DAS(disease activity score)28CRP between BAR 2mg and 4mg. The patient background treated in these double-blind RCTs is uniform even at different BAR doses.There is uncertainty about the difference in the therapeutic effects of BAR dose under the real clinical setting where the patient background differs from that of the trial patients.Objectives:To compare patient backgrounds and treatment outcome by Baricitinib dose under real clinical setting.Methods:113 RA patients taking BAR who were registered in the Nagoya University Orthopedic Surgery Multicenter Study (TBCR) were included in this study. Patient characteristics (such as age, illness duration, combined anti-rheumatic drugs, eGFR) and DAS28CRP, clinical and simplified disease activity index(CDAI, SDAI respectively) up to 24 weeks were compared between BAR 2mg and 4mg groups. The continuation rates, including the discontinuation due to ineffectiveness and adverse events (AEs), were also compared between the two groups. For these comparisons, Student’s t-test and Pearson’s chi-square test, Kaplan-Meier survival curve were used. Missing data due to discontinuation of BAR was complemented by LOCF method and analyzed statistically. The significance level was set to less than 0.05.Results:There were 39 subjects (8 males and 31 females) in BAR2mg group and 74 patients (17 males and 57 females) in BAR4mg group. There was a significant difference in mean age (73.5 vs. 62.3 years old,p2,pppppConclusion:BAR2mg group under real clinical setting was older and had lower eGFR than BAR4mg group. Although the treatment effect for 24 weeks was similar, safety management was considered more important because the discontinuation rate due to AEs tended to be higher in BAR2mg group.References:[1]Taylor PC, (2017) The New England journal of medicine. 376(7), 652.[2]Takeuchi T, Ann Rheum Dis 2019;78:171–178.[3]Keystone EC, Ann Rheum Dis 2015;74:333–340Table 1.ITT outcomes at week 13BAR2mg (n=39)BAR4mg (n=74)pvalueAge, years old73.5±9.762.3±12.6Female31(79)57(77)0.767Disease duration, year13.7±11.314.2±15.40.857Stage(1/2/3/4)6/17/8/815/24/14/210.473ACPA >4.5U/ml29(74.4)59(79.7)0.629eGFR, ml/min/1.73m265.1±27.784.8±23.2MTX dose, mg/week3.03±4.835.54±5.480.018MTX use11(28.2)41(55.4)0.003GC dose, mg/day1.91±2.361.32±2.200.191GC use20(51.3)25(33.8)0.007DAS28CRP3.42±1.043.52±13.00.689CDAI12.6±7.615.1±10.90.222SDAI14.7±9.716.2±11.40.279Values are the mean±SD or the number (%).Disclosure of Interests:Tsuyoshi Nishiume: None declared, Nobunori Takahashi Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Janssen, Mitsubishi Tanabe, Ono, Pfizer, Takeda, and UCB Japan, Toshihisa Kojima Grant/research support from: Chugai, Eli Lilly, Astellas, Abbvie, and Novartis, Consultant of: AbbVie, Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Janssen, Mitsubishi Tanabe, Pfizer, and Takeda, Shuji Asai Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Janssen, Takeda, and UCB Japan, Kenya Terabe: None declared, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant of: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama

Background:Therapeutic decisions in RA patients should be based on regular disease activity assessment using scores like the Simplified Disease Activity Index (SDAI) or the Clinical Disease Activity Index (CDAI) [1]. The CDAI has the benefit of being immediately available, while the SDAI encompasses with the C-reactive protein (CRP) an acute phase reactant and therefore is the recommended score for the use in clinical trials. However, CRP determination takes hours to days, thus hindering the treat-to-target concept using the SDAI. Quick quantitative CRP (qCRP) tests allow CRP measurement within a few minutes. Therefore, qCRP based SDAI (SDAI-Q) could combine the advantages of both scores.Objectives:To validate the SDAI-Q in a prospective, multicenter study of RA patients.Methods:The study was conducted in five centers in Berlin, Germany. Consecutive adult (≥ 18 years) RA patients were included. In addition to a rheumatological assessment, including patient reported outcomes, routine CRP was measured in the local labs. Additionally, a qCRP testing with the „QuikRead go instrument“ (Aidian Oy, Finland) was performed locally (measurement range 0.5 - 200 mg/l). Statistical analysis included descriptive statistics, cross tabulation and weighted Cohen´s kappa comparing disease activity categories, Bland-Altman plots and intraclass correlation coefficient (ICC) for CRP, qCRP, SDAI, SDAI-Q and CDAI.Results:In this study 100 RA patients were included (mean age: 60.9 years, mean disease duration: 11.4 years, 73.0% were female, 63.0% RF positive, 57.0% ACPA positive, 49.0% positive and 29% negative for both parameters). 75.0% were treated with csDMARD, 15% with tsDMARDs, 39.0% with bDMARDs and 40% with glucocorticoids (mean prednisolone equivalent: 5.4 mg prednisolone/d). Mean CRP and qCRP-levels were 6.97 and 7.89 mg/l, respectively (ICC 0.992; 95%CI: 0.987; 0.995). Comparing SDAI-Q and SDAI, all patients (100%) achieved the same disease activity status (Table 1A); weighted Cohen´s kappa was 1.000 (95%CI: 1.000; 1.000). ICC for SDAI-Q- and SDAI-values was 1.000 (95%CI: 1.000; 1.000). The agreement of SDAI-Q and SDAI is shown in a Bland-Altman plot (Figure 1). When comparing the CDAI with the SDAI-Q 93 patients (93%) were assigned to the same disease activity category (Table 1B); weighted Cohen´s kappa was 0.929 (95%CI: 0.878; 0.981). ICC for numerical values of SDAI-Q and CDAI was 0.989 (95%CI: 0.978; 0.994).Conclusion:SDAI-Q showed an absolute agreement with SDAI on the assignment to disease activity categories with the important advantage of time. With SDAI-Q, rheumatologists could base their clinical decision-making immediately on an index-based disease activity measurement by using a composite score considering acute phase reactants. Consequently, SDAI-Q can be integrated in clinical routine and clinical trials and could be implemented into the treat-to-target concept in RA patients.References:[1]Smolen JS, et al. Ann Rheum Dis. 2016 Jan; 75(1):3-15.Table 1.A) Disease activity categories by SDAI-Q vs. SDAI; B) Disease activity categories by SDAI-Q vs. CDAIASDAI-Q (n = 100)Remission (≤ 3.3)Low Disease Activity (> 3.3 and ≤ 11)Moderate Disease Activity (> 11 and ≤ 26)High Disease Activity (> 26)SDAIRemission (≤ 3.3)28 (28.0%)Low Disease Activity (> 3.3 and ≤ 11)31 (31.0%)Moderate Disease Activity (> 11 and ≤ 26)35 (35.0%)High Disease Activity (> 26)6 (6.0%)BSDAI-Q (n = 100)Remission (≤ 3.3)Low Disease Activity (> 3.3 and ≤ 11)Moderate Disease Activity (> 11 and ≤ 26)High Disease Activity (> 26)CDAIRemission (≤ 2.8)26 (26.0%)Low Disease Activity (> 2.8 and ≤ 10)2 (2.0%)28 (28.0%)2 (2.0%)Moderate Disease Activity (> 10 and ≤ 22)3 (3.0%)33 (33.0%)High Disease Activity (> 22)6 (6.0%)Fields highlighted in red indicate that disease activity categories do not match.SDAI = Simplified Disease Activity Index;SDAI-Q = SDAI calculated with a quick quantitative CRP assay;CDAI = Clinical Disease Activity Index.Figure 1.Bland-Altman plot for SDAI and SDAI-Q AcknowledgementsThe authors would like to deeply thank Braun T, Doerwald C, Deter N, Höppner C, Lackinger J, Lorenz C, Lunkwitz K, Mandt B, Sron S and Zernicke J for their practical support and coordinating the study.Funding statement:The AQUA study was supported by an unrestricted research grant from Novartis. Testing kits were provided free of charge from Aidian Oy, Finland.Disclosure of Interests:None declared

Background:Routine Assessment of Patient Index Data 3 (RAPID3) is a pooled index of 3 patient-reported measures: patient global assessment, pain, and physical function. RAPID3 was shown to correlate with other composite measures of disease activity1 and is recommended by the American College of Rheumatology for use in clinical practice.2Objectives:To evaluate the impact of upadacitinib (UPA) versus comparators on RAPID3 over 60 weeks, as well as the correlation of RAPID3 scores with other disease measures in the UPA phase 3 SELECT clinical program.Methods:This post hoc analysis included placebo-controlled (SELECT-NEXT, -BEYOND, and -COMPARE) and active comparator-controlled (SELECT-EARLY, -MONOTHERAPY, and -COMPARE) trials. Patients received UPA as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Mean change from baseline in RAPID3 and the proportion of patients reporting RAPID3 remission (≤3), low (LDA, >3 to ≤6), moderate (MDA, >6 to ≤12), and high disease activity (HDA, >12) were assessed. Correlations between absolute scores for RAPID3 and Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and 28-joint Disease Activity Score with C-reactive protein (DAS28[CRP]) were assessed using Spearman correlation coefficients. All data are as observed.Results:A total of 661, 498, 648, 1629, and 945 patients were included from SELECT-NEXT, -BEYOND, -MONOTHERAPY, -COMPARE, and -EARLY. At baseline, the majority of patients across all studies were in RAPID3 HDA (mean baseline RAPID3 [across all studies], 17.2–19.2) (Table 1 and Figure 1). Improvements from baseline in RAPID3 were observed with UPA 15 mg and 30 mg through Week 60, with numerically greater improvements observed with UPA compared with active comparators (Table 1). Across studies, mean improvements in RAPID3 exceeded the minimal clinically important difference (MCID) with UPA and adalimumab (ADA) treatment (MCID=3.83). By Week 60, approximately one-half of UPA-treated patients were in RAPID3 remission or LDA, with only 10–25% remaining in HDA, except for the more refractory population in SELECT-BEYOND, in which ~38% of patients remained in HDA (Figure 1). RAPID3 scores moderately to strongly correlated with CDAI (ρ=0.69–0.83), SDAI (ρ=0.69–0.82), and DAS28(CRP) (ρ=0.58–0.77), across all studies, at Week 60 (all pConclusion:UPA, as monotherapy or in combination with csDMARDs, was associated with improvements in patient-reported disease activity, pain, and physical function, as assessed by RAPID3 over 60 weeks in the phase 3 SELECT clinical program. RAPID3 continues to be an important tool in clinical practice to assess disease activity, as it was shown to correlate to other disease activity measures and allows for rapid scoring.References:[1]Pincus T, et al. Arthritis Care Res (Hoboken) 2010;62:181–9.[2]England BR, et al. Arthritis Care Res (Hoboken) 2019;71:1540–55.[3]Ward MM, et al. J Rheumatol 2019;46:27–30.Table 1.Change from BL in RAPID3 at Week 60 (as observed)Phase 3 studyGroupnaMean (SD) BL scoreMean (SD) change from BLbSELECT-EARLYc(MTX-naïve)MTX23618.5 (5.6)−9.6 (7.5)UPA 15 mg QD26918.9 (5.6)−12.0 (7.6)UPA 30 mg QD25318.2 (5.6)−13.4 (7.2)SELECT-NEXT(csDMARD-IR)UPA 15 mg QD17217.7 (5.1)−11.1 (7.3)UPA 30 mg QD17217.6 (5.3)−10.4 (6.8)SELECT-MONOTHERAPY(MTX-IR)UPA 15 mg QD17217.4 (5.8)−9.6 (7.4)UPA 30 mg QD18017.2 (5.9)−10.6 (7.2)SELECT-COMPAREc(MTX-IR)UPA 15 mg QD55218.5 (5.5)−10.2 (7.1)ADA 40 mg EOW26418.7 (5.4)−8.8 (6.7)SELECT-BEYOND(bDMARD-IR)UPA 15 mg QD13319.2 (5.1)−8.6 (6.8)UPA 30 mg QD11818.5 (5.3)−9.3 (7.3)b, biologic; BL, baseline; EOW, every other week; IR, inadequate response; MTX, methotrexate; QD, once daily; SD, standard deviationaNumber of patients with RAPID3 values at both BL and Week 60. bNegative values indicate improvement from BL. cObserved data include patients rescued to UPA and/or ADA; treatment effect may include both the randomized and switch treatments in these patientsAcknowledgements:AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Grant Kirkpatrick, MSc, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.Disclosure of Interests:Martin Bergman Shareholder of: Johnson & Johnson, Speakers bureau: AbbVie, Celgene, GSK, MSD, Novartis, Pfizer, and Sanofi/Regeneron, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Genentech/Roche, Gilead, Horizon, Janssen, MSD, Novartis, Pfizer, Sandoz, Sanofi/Regeneron, and Scipher, Maya H Buch Consultant of: AbbVie, Eli Lilly, Merck-Serono, Pfizer, Sandoz, and Sanofi, Grant/research support from: Pfizer, Roche, and UCB, Yoshiya Tanaka Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, GSK, Janssen, Mitsubishi Tanabe, Novartis, Pfizer, Sanofi, Takeda, UCB, and YL Biologics, Grant/research support from: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Mitsubishi Tanabe, MSD, Ono, Taisho Toyama, and Takeda, Gustavo Citera Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Genzyme, Pfizer, and Roche, Sami Bahlas: None declared, Ernest Wong Consultant of: AbbVie, Chugai, Eli Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Chugai, Novartis, and UCB, Yanna Song Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Namita Tundia Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Jessica Suboticki Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Vibeke Strand Consultant of: AbbVie, Amgen, Arena, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Celltrion, Eli Lilly, Gilead, Ichnos, Inmedix, Janssen, Kiniksa, MSD, Myriad Genetics, Novartis, Pfizer, Regeneron, Samsung, Sandoz, Sanofi, Scipher, Setpoint, and UCB.

Objectives:Rheumatoid arthritis (RA) is a chronic inflammatory disease that involves various joints in whole body. For evaluation of daily life activities (ADL), modified Health Assessment Questionnaire (mHAQ) is usually used. This index configures eight ADL functions these are separated by predominant extremities. This study aimed to evaluate how involved joint affect ADL predominantly in real world setting.Methods:A total of 24,450 times of consultation with RA patient were visited in the institute. Here, patient with RA was interviewed every another visit, and involved joint in whole body, pain score with visual analog scale (PS-VAS), and mHAQ were recorded. Involved joints were divided by four regions in accordance with joint size and part; small joint in upper extremities (US), large joint in upper extremities (UL), small joint in lower extremities (LS), and large joint in lower extremities (LL). mHAQ was also separately evaluated in accordance with predominant regions; upper extremities predominant mHAQ (mHAQ_UE), and lower extremities predominant mHAQ (mHAQ_LE). Adding to these parameters, as an index for disease activity monitoring, components of the simplified disease activity index score (SDAI) was also recorded. Relationship between mHAQ for each predominant extremities, and these parameters and sex, age, disease duration of RA, anti-cyclic citrullinated polypeptide antibodies (ACPA), rheumatoid factor (RF), and Sharp/van der Heijde score (SHS), were statistically evaluated using linear regression analysis.Results:mHAQ_UE significantly correlated with age, ACPA and RF titre, SHS, tenderness joint count (TJC), patient’s global assessment (PGA), evaluator’s global assessment (EGA), C-reactive protein (CRP), US, UL, LL, and PS-vas, whereas mHAQ-LE significantly correlated with all parameters that demonstrated significant correlation with mHAQ-UE and disease duration. mHAQ also correlated with all parameters those that demonstrated significant correlation with mHAQ-LE. Interestingly, all of mHAQ-UE, mHAQ-LE, and mHAQ did not correlated significantly with swollen joint count (SJC) and LS.Conclusion:mHAQ is influenced by various factors, however, SJC and involvement of small joint in lower extremities did not affect mHAQ.Disclosure of Interests:None declared

Background:We previously reported that glucocorticoid (GC) use was an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis (RA)1. On the other hand, sarcopenia was not associated with deterioration of muscle function (dynapenia)2.Objectives:Factors associated with deterioration of muscle quality and function were prospectively investigated.Methods:Muscle quality and function were examined by measuring power, speed, and balance in standing-up motion using an exercise functional analysis device (BM-220, Tanita, Japan) at baseline and at 2-year follow-up in the prospective, observational CHIKARA study. Associations between changes in these parameters (Δ muscle quality, Δ muscle function) and body composition, disease activity, treatment, physical function, and history of falls and fractures were investigated by univariate and multivariate analyses.Results:Eighty-one RA patients completed the survey. Their average age was 66 years, disease duration was 5.3 years, the simplified disease activity index (SDAI) was 5.3, and the modified Health Assessment Questionnaire (mHAQ) was 0.25 at baseline. Of the patients, 12.3% used GCs at an average dose of 3.08 mg/day over 2 years. The average GC dose was negatively correlated with changes in muscle quality (r=-0.25, p=0.03), power (r=-0.23, p=0.04), and speed (r=-0.24, p=0.03). The SDAI at baseline was negatively correlated with power (r=-0.23, p=0.04) and speed (r=-0.22, p=0.05) (Table 1). No factor was associated with the mHAQ and a history of falls. No independent factor was identified on multiple regression analysis.Table 1.Associations between changes in muscle quality and function and body composition, disease activity, treatment, physical function, and history of falls and fracturesΔ muscle qualityΔ muscle functionpowerspeedbalancerprprprpage, years-0.210.063-0.110.337-0.230.0410.180.105GC dose, mg/day-0.250.025-0.230.041-0.240.032-0.020.883CRP, mg/dl0.010.9100.030.7810.030.7990.200.067MMP-3, ng/ml-0.250.022-0.130.249-0.170.1340.020.847DAS28ESR-0.090.441-0.050.665-0.090.4350.010.961SDAI-0.140.216-0.230.041-0.220.0480.010.917mHAQ-0.130.248-0.040.728-0.060.578-0.060.585SMI, kg/m20.030.7640.9980.030.7610.240.034BMR, kcal/day0.050.2780.010.960.110.3220.180.111fall0.070.5310.120.2860.020.871-0.020.852fracture0.9730.989-0.050.677-0.190.097Δ, changes from baseline; GC, glucocorticoid; CRP, C-reactive protein; MMP-3, matrix metalloproteinase 3; DAS, Disease Activity Score; ESR, erythrocyte sedimentation rate; SDAI, simplified disease activity index; mHAQ, modified Health Assessment Questionnaire; SMI, skeletal muscle index; BMR, basal metabolic rate.Conclusion:GC use was associated with deterioration in muscle quality and function, as well as sarcopenia development. GC use adversely affected muscle mass, quality, and function. In addition, since high disease activity led to low exercise function, disease activity control is important to prevent deterioration of exercise function.References:[1]Y Yamada, M Tada, K Mandai et al. Glucocorticoid use is an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis: from the CHIKARA study. Clin Rheumatol 2020 Jan 14. Epub ahead of print.[2]M Tada, Y Yamada, K Mandai et al. Correlation between frailty and disease activity in patients with rheumatoid arthritis: Data from the CHIKARA study. Geriatr. Gerontol. Int. 2019;19:1220-25.Disclosure of Interests:Yutaro Yamada: None declared, Masahiro Tada: None declared, Koji Mandai: None declared, Noriaki Hidaka: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

For patients with rheumatoid arthritis (RA), remission can be achieved with tight control of inflammation and early use of disease modifying agents. The importance of remission as an outcome has been recently highlighted by European League Against Rheumatism recommendations. However, remission when defined by clinical remission criteria (disease activity score, simplified disease activity index, etc) does not always equate to the complete absence of inflammation as measured by new sensitive imaging techniques such as ultrasound (US) . There is evidence that imaging synovitis is frequently found in these patients and associated with adverse clinical and functional outcomes. This article reviews the data regarding remission, ultrasound imaging and outcomes in patients with RA to provide the background to a consensus statement from an international collaboration of ultrasonographers and rheumatologists who have recently formed a research network - the Targeted Ultrasound Initiative (TUI) group. The statement proposes that targeting therapy to PD activity provides superior outcomes compared with treating to clinical targets alone and introduces the rationale for a new randomised trial using targeted ultrasound in RA.

Background Baricitinib (bari), a JAK1 and JAK2 inhibitor, showed significant improvements across multiple measures of disease activity as early as week (wk) 1 that were maintained through wk 52 in ph 3 studies of patients (pts) with active RA.1,2 Objectives To determine if, in bari-treated pts, early changes in disease activity predicted later achievement of low disease activity (LDA) or remission. Methods 1305 pts with inadequate response to methotrexate (MTX) were randomized in RA-BEAM (3:3:2, oral PBO/4 mg bari QD/SC injection adalimumab [ADA] Q2W, 52 wks); 584 MTX-naive pts were randomized in RA-BEGIN (4:3:4, oral MTX QW/4 mg bari QD/4 mg bari QD+MTX QW, 52 wks). Improvement from baseline (BL) to wk 4 was used to predict LDA or remission defined by Disease Activity Score (DAS28) and Simplified Disease Activity Index (SDAI) at wks 12/24 (bari 4 mg arm, both studies). Early responder and early nonresponder were predefined as Clinical Disease Activity Index (CDAI) improvement ≥6 and Results Compared to PBO or ADA (RA-BEAM) or MTX (RA-BEGIN), treatment with bari was associated with rapid decrease in DAS28 and CDAI from wk 1.1,2 By wk 4, 86% (RA-BEAM) and 85% (RA-BEGIN) of bari pts had a CDAI decrease ≥6. In both studies, LDA/remission rates at wks 12/24 were higher in pts with CDAI improvement ≥6 compared to pts with CDAI improvement Conclusions In RA-BEAM/RA-BEGIN, lack of early clinical response to bari 4 mg (failure to achieve CDAI improvement ≥6 at 4 wks) was associated with low rates of LDA/remission at wks 12/24. These results are consistent with similar analyses from previous ph 3 studies of bari.3 The majority of bari pts had improvement in CDAI ≥6 at wk 4; these decreases were associated with improved clinical responses at wks 12/24. Early identification of pts (4 wks) who are not likely to achieve LDA/remission may be useful in tailoring therapy to individual pts. References Taylor PC et al. Arthritis Rheumatol. 2015; 67 (suppl 10). Fleischmann R et al. Arthritis Rheumatol. 2015; 67 (suppl 10). Kremer J et al. Arthritis Rheumatol. 2015; 67 (suppl 10). Disclosure of Interest M. Weinblatt Grant/research support from: Crescendo Bioscience, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, Crescendo Bioscience, P. Taylor Grant/research support from: UCB, GlaxoSmithKline, Celgene, Consultant for: AbbVie, Bristol-Myers Squibb, Eli Lilly and Company, Galapagos, GlaxoSmithKline, Merck, Pfizer, Takeda, USB, Y. Tanaka Grant/research support from: Mistubishi-Tanabe, Takeda, Chugai, Astellas, Eisai, Taisho-Toyama, Kyowa-Kirin, Abbvie, Bristol-Myers, Speakers bureau: Abbvie, Daiichi-Sankyo, Chugai, Takeda, Mitsubishi-Tanabe, Bristol-Myers, Astellas, Eisai, Janssen, Pfizer, Asahi-kasei, Eli Lilly, GlaxoSmithKline, UCB, Teijin, MSD, Santen, E. Keystone Grant/research support from: Abbott Laboratories, Amgen Inc., AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb, Eli Lilly and Company, F. Hoffmann-La Roche Inc, Janssen Inc, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, UCB, Consultant for: Abbott Laboratories, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Eli Lilly and Company, F. Hoffmann-La Roche Inc, Genentech Inc, Janssen Inc, Merck, Pfizer Pharmaceuticals, UCB, Speakers bureau: Abbott Laboratories, Astrazeneca LP, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Pfizer Pharmaceuticals, UCB, Amgen, M. Schiff Grant/research support from: Eli Lilly and Company, Consultant for: Eli Lilly and Company, R. Fleischmann Grant/research support from: Eli Lilly and Company, Pfizer, Consultant for: Eli Lilly and Company, Pfizer, L. Yang Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, V. Arora Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, S. de Bono Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, T. Holzkaemper Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, D. Schlichting Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, T. Takeuchi Grant/research support from: Eli Lilly and Company, Chugai Pharmaceutical Co,. Ltd, Consultant for: Eli Lilly and Company

Background ABP 501 is being developed as a biosimilar candidate to adalimumab, a fully human recombinant monoclonal antibody. Evidence from analytical and pharmacokinetic comparisons indicates that ABP 501 is highly similar to adalimumab. Results of efficacy and safety from a phase 3 study comparing ABP 501 with adalimumab in subjects with rheumatoid arthritis (RA) have been previously presented. 1,2 Objectives To report descriptive results from additional efficacy analysis based on clinical disease activity index (CDAI) and simplified disease activity index (SDAI) composite indices as well as results for the ACR individual components. These analyses provide information on alternate methods for disease management. Methods This was a randomized, double-blind, active-controlled study in adult subjects with moderate to severe RA who had an inadequate response to methotrexate. Subjects were randomized in a 1:1 ratio (ABP 501: n=264; adalimumab: n=262) to receive either ABP 501 or adalimumab 40 mg subcutaneously every 2 weeks. Details of the study design have been previously reported. 1 For these analyses descriptive summaries of CDAI, SDAI and individual American College of Rheumatology response criteria (ACR) components were generated. Results Baseline characteristics were well balanced between groups. At week 24, the mean (SD) CDAI improvement from baseline was 25.94 (12.62) for ABP 501 and 25.06 (12.02) for adalimumab. At week 24, the mean (SD) SDAI improvement from baseline was 26.57 (12.97) for ABP 501 and 25.64 (12.31) for adalimumab. Results for CDAI, SDAI and individual ACR components at baseline and week 24 are shown in the Table. The overall safety and immunogenicity profile of ABP 501 was comparable to that of adalimumab and has been previously reported. 1,2 Conclusions These additional analyses confirm that the of efficacy ABP 501 is comparable to adalimumab in multiple clinical characterisitics providing further evidence that ABP 501 is similar to adalimumab. References Cohen et al. Presented at: American College of Rheumatology Annual Meeting; November 2015; San Francisco, CA. Abstract 2054. Matsumoto et al. Presented at: American College of Rheumatology Annual Meeting; November 2015; San Francisco, CA. Abstract 2757. Acknowledgement Monica Ramchandani, PhD for medical writing. Disclosure of Interest S. Cohen Consultant for: Amgen, N. Zhang Shareholder of: Amgen, Employee of: Amgen, P. Kaur Shareholder of: Amgen, Employee of: Amgen

Background The presence of rheumatoid factor (RF) is associated with progression of joint damage in patients with rheumatoid arthritis (RA). RF levels may change during the course of therapy1, but it is not clear, if such changes also reflect a change in prognosis of RA. Objectives Here, we aimed to investigate whether fluctuation of RF levels is an independent marker of progression of RA. Methods We identified 239 RA outpatients based on classifiable RA by the 2010 ACR/EULAR classification criteria, the presence of at least two available radiographs of hands and feet (2–4 years apart), the availability of repeated measurements of RF (at least two/year), and positive initial RF levels (≥50 IU/ml; for the possibility of fluctuation). Radiographic images were scored using the modified Sharp/van der Heijde (SvH) method. A total of 375 radiographic intervals could be included, since some of the patients had more than one included observation periods. Logistic regression analysis was used to examine the effect of fluctuating RF levels (expressed as standard deviation of all RF measurements between the two radiographs) on significant damage progression (defined by an average increase of ≥3 on the SvH score per year); results were adjusted for mean RF levels over time, disease activity (expressed as Simplified Disease Activity Index – SDAI), percentage time on biologics and already existing radiographic damage. Results Mean (SD) RF levels were 351.4 (618.7) IU/ml at baseline and 253.7 (424.2) IU/ml at the time of the second radiograph (p Univariate logistic regression showed a clear association of higher standard deviations of RF levels with radiographic progression (p=0.015). When adjusting this effect for mean RF levels, disease activity (time-integrated levels of SDAI), percentage time on biologics and already existing radiographic damage, the association of standard deviation of RF levels on radiographic progression was lost (p=0.087), whereas disease activity (p When adjusting for each of these predictors individually, the association remained unchanged when tested against time on biologics only (p=0.016), or pre-existing damage only (p=0.048). Even adjusting for mean RF levels only left a significant independent association (p=0.032), while the mean RF levels were not significant (p=0.146). Only when adjusted for time-integrated disease activity, standard deviation of RF lost significance on the association with radiographic progression (p=0.126; Table). Conclusions Fluctuations of RF levels are associated with radiographic progression in RA. This effect is independent of mean RF levels over time, but seems to be associated with, or a consequence of, disease activity. Further studies need to explore the direction of causality of these observations. References Serological changes in the course of traditional and biological disease modifying therapy of rheumatoid arthritis. Bohler C et al. Ann Rheum Dis, 2013 Feb;72(2):241–4. Disclosure of Interest None declared

Background There are several definitions of remission (REM), which are composite measures, including physician, laboratory, and patient (pt) assessments. The Boolean definition of REM is the most stringent. Objectives To determine which components limit pts from achieving REM based on the Boolean definition. Methods Pt data originated from 3 trials: PREMIER [treatment-naive pts with early RA treated with methotrexate (MTX) alone or MTX + adalimumab (ADA)]; OPTIMA-arm 5 (pts with early RA, who failed MTX treatment, treated with open-label ADA + MTX); DE019 (pts with established RA treated with MTX alone, or MTX+ ADA, 20/40 mg every other wk). The Simplified Disease Activity Index (SDAI) is comprised of swollen and tender joint count (SJC/TJC, 0-28 joints), pt and physician global disease activity (PGA/PhGA, 0-10 cm VAS), and C-reactive protein, (CRP mg/dL); SDAI REM is defined as a score of ≤3.3. The 28-joint Disease Activity Score based on C-reactive protein [DAS28(CRP)] is comprised of SJC28, TJC28, CRP (mg/L) and PGA (0-10 cm VAS); DAS28 REM is defined as a score of

Background Anticyclic citrullinated peptide antibodies (ACCP) are considered a diagnosis criteria for rheumatoid arthritis (RA). However, it is unknown if there is a correlation between the levels of these antibodies and the disease activity, or their utility for the individual follow-up. Objectives The aim of this study is to investigate the association between disease activity and levels of ACCP and rheumatoid factor (RF) in RA patients. As disease activity markers, Disease Activity Score (DAS28 PCR), Simplified Disease Activity Index (SDAI) and a Spanish version of the Health Assessment Questionnaire (HAQ) are used. Methods DAS28 (PCR), SDAI and HAQ were evaluated in 62 sera of 42 RA patients, diagnosed according to the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria. In all of them, AACP (Thermofisher) and RF were measured. Results When we analyze the different correlations between AACP, RF and DAS28 (PCR), SDAI and HAQ, we find no correlation between then. Figure 1: Pearson correlation (r) among serological data - anticyclic citrullinated peptide antibodies (ACCP) and rheumatoid factor (RF) - and clinical data - Disease Activity Score 28 (DAS28 PCR), Simplified Disease Activity Index (SDAI) and Health Assessment Questionnaire (HAQ) - in diagnosed RA patients. Conclusions We find no correlation between serological and disease activity markers in RA patients. Consequently, although ACCP and RF are essential for the RA diagnosis, are not useful as disease activity indicators, and their continuous measurement in the monitoring of patients would not be indicated. Disclosure of Interest None declared

Background Various definitions of remission in Rheumatoid Arthritis (RA) have been proposed. The Disease Activity Index 28 joints (DAS28) is the routinely used score. Newer tools for evaluation of RA activity include the Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) are available and have proved to be more stringent. Objectives The purpose of this study was to compare the accuracy of composite scores of remission in RA patients using the absence of inflammatory activity detected by ultrasound (US) as a gold standard. Methods Sixty seven patients followed-up for RA were recruited. B-mode and a Power Doppler (PD) US exam were assessed by a single rheumatologist who was experienced in US and blinded to the clinical and laboratory data. Twenty two joints were scanned (wrists, 10 metacarpophalangeal (MCP) and proximal interphalangeal (PIP)). SDAI and CDAI were calculated for each patient. Sensitivity, specificity and Positive Predictive value (PPV) for each score was calculated with as reference absence of Doppler signal in US. Then ROC curve were analyzed. Results Among all patients, 30 were in remission according to the DAS28, 19 according to SDAI and 26 according to CDAI. For 19 patients there was no Doppler signal in US. The sensitivity and specificity of different remission scores considering as reference absence of joints with PD signal is showed in table 1. The ROC curves showed that the best threshold of DAS28 was 3.2. It was 6.5 for SDAI and 8 for CDAI. Conclusions Ours results suggest that when considering remission as an absence of Doppler signal, the DAS28 was the most sensitive and the CDAI was the most specific. The ROC curves showed threshold exceeding definition of remission. References Balsa A, De Miguel E and col. Superiority of SDAI over DAS-28 in assessing remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard. Rheumatology 2010. Disclosure of Interest None declared

Background New generation of scores to evaluate rheumatoid arthritis (RA) activity has been developed with current insights the importance of close monitoring patients and controlling disease activity. The Simplified Disease Activity Index (SDAI) is simple and easy score, it is well correlated to the RA activity and is less time-consuming in calculation than DAS. In the other hand, ultrasonography (US) showed more sensitivity in detecting synovitis than clinical examination. Objectives The purpose of this study is to compare the clinical and US activity of RA by the SDAI and the US-SDAI. Methods Fifty patients followed-up for active RA were included. The SDAI was calculated by the numerical summation of the number of tender joints, swollen joints (/28 joints), the patient9s and doctor9s evaluation of the disease and the C protein reactive value. Then patients underwent US examination by a radiologist experimented and blinded to clinical data. Twenty two joints of the hands were scanned (wrists, 10 metacarpophalangeal and 10 proximal inter-phalangeal). The US-SDAI was calculated by replacing the swollen joints of the hands by joints expressing B-mode or Power Doppler activity in the US exam. Results Fifty patients were recruited with a mean age of 53,8 years-old [26-78]. Females outnumbered males (42/8). The mean duration of illness was 3,6 years [0,5-15]. Rheumatoid factor was positive in 55% of patients. The mean number of swollen joints of hands found in physical exam was 4 and was 4,2 for US (p=0.82). The mean value of US-SDAI (29.2) was a little bit higher than the clinical one (29) and the difference was not significant (p=0.82). There was a highly significant positive correlation between SDAI and US-SDAI (p Conclusions In our study clinical SDAI seems to be well correlated to US-SDAI. Since the SDAI is simple to calculate and should be more used in our daily practice. Disclosure of Interest None declared

Background In the treat-to-target strategy (T2T) 1 , simplified disease activity index (SDAI) has been proposed as one of measures to define remission 2 . Predictive ability of SDAI remission for functional and structural outcomes was shown by data from clinical trials, but has not been proven in a T2T implementing cohort. Objectives To examine if achieving SDAI remission is a predictor of good functional and structural outcomes in a T2T implementing cohort. Methods The T2T Epidemiological Study is a multi-centre, prospective cohort study, in which RA patients with moderate to high disease activity were enrolled and treated with T2T for 72 weeks. The disease activity was assessed every 12 weeks and the treatment was adjusted accordingly. Primary outcomes were HAQ and ΔmTSS at week 72. Multivariate logistic regression analysis was used to examine association between SDAI remission at week 24 and the two primary outcomes. Missing data were imputed using the multiple imputation method. Statistical significance levels were adjusted for multiple comparison using False Discovery Rate and BH methods. Results Of total 318 enrolled patients, 244 patients followed up for 72 weeks were analysed. Patient characteristics were as follows: female, 77%; mean age, 61; mean disease duration, 57 months. At week 24, 33% achieved SDAI remission. At week 72, 50% achieved SDAI remission, 61% achieved HAQ remission (≤0.5) and 73% showed ΔmTSS p= 0.009], baseline HAQ [0.30 (0.19-0.47), p =2.4x10 -7 ], absence of history of joint replacement related to RA [9.90 (1.57-62.5), p =0.015] and SDAI remission at week 24 [3.24 (1.57-6.71), p =0.0015]. Factors associated with ΔmTSS p =0.0037], serum MMP-3 level at week 24 [0.998 (0.996-1.000), p =0.035] and SDAI remission at week 24 [3.21 (1.46-7.02), p =0.0036]. Conclusions SDAI remission at week 24 is a significant predictor of good functional and structural outcomes at week 72 in the T2T implementing cohort. References Ann Rheum Dis 2010;68:631-637. 2. Ann Rheum Dis. 2011;70:404-413. Acknowledgements We all thank all health care professionals and patients who participated in this study. Disclosure of Interest F. Hirano: None declared, W. Yokoyama: None declared, H. Yamazaki Grant/research support from: Abbvie Japan Co., Ltd., Astellas Pharma Inc., Bristol Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Ono Pharmaceuticals, Pfizer Japan Inc., Sanofi-Aventis KK., Santen Pharmaceutical Co., Ltd., Sekisui Medical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Ltd., and UCB Japan, K. Amano Grant/research support from: Astellas, Chugai, Pfizer, Tanabe-Mitsubishi, Consultant for: Zenyaku Kogyo, Paid instructor for: Chugai, Pfizer, Santen, Tanabe-Mitsubishi, Speakers bureau: AbbVie, Actellion, Astellas, Bristol-Myers-Squibb, Chugai, Diichi-Sankyo, Eisai, Pfizer, Tanabe-Mitsubishi, Y. Kaneko Consultant for: Abbvie, Paid instructor for: Eisai Pharmaceutical, Chugai Pharmaceutical, Astellas Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Pfizer, Speakers bureau: Abbvie, Eisai Pharmaceutical, Chugai Pharmaceutical, Bristol Myers Squibb, Astellas Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Pfizer, Janssen, UCB, A. Kawakami Grant/research support from: Abbvie GK, Eisai Co., Mitsubishi Tanabe Pharma Co., Pfizer Japan, Janssen Pharmaceutical K. K., Takeda Pharmaceutical Company, Astellas Pharma Inc., Santen Pharmaceutical Co., Bristol-Myers Squibb, ONO Pharmaceutical Co., Chugai Pharmaceutical Co., Taisho Toyama Pharmaceutical Co., Speakers bureau: Abbvie GK, Eisai Co., Mitsubishi Tanabe Pharma Co., Pfizer Japan, Janssen Pharmaceutical K. K., Takeda Pharmaceutical Company, Astellas Pharma Inc., Santen Pharmaceutical Co., Bristol-Myers Squibb, ONO Pharmaceutical Co., Chugai Pharmaceutical Co., Taisho Toyama Pharmaceutical Co., T. Matsui: None declared, R. Sakai Grant/research support from: Abbvie Japan Co., Ltd., Astellas Pharma Inc., Bristol Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Ono Pharmaceuticals, Pfizer Japan Inc., Sanofi-Aventis KK., Santen Pharmaceutical Co., Ltd., Sekisui Medical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Ltd., and UCB Japan, R. Koike: None declared, N. Miyasaka Grant/research support from: Abbott Japan Co., Ltd., Astellas Pharma Inc., Bristol Myers Squibb, Chugai Pharmaceutical Co., Ltd., Dainihon-Sumitomo Pharma Co. Ltd., Daiichi-Sankyo Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma Co., Novartis Pharma K.K., Ltd., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Ltd, Consultant for: Abbott Japan Co., Ltd., Bristol Myers Squibb, Janssen Pharmaceutical KK, and Otsuka Pharmaceutical Co. Ltd., M. Harigai Grant/research support from: Abbvie Japan Co., Ltd., Astellas Pharma Inc., Bristol Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Ono Pharmaceuticals, Santen Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and UCB Japan, Consultant for: Chugai Pharmaceutical Co., Ltd., Janssen Pharmaceutical KK, Teijin Pharma Ltd.

Background Remission and low disease activity (LDA) are now more achievable goals in RA. Year 1 and 2 data from the head-to-head AMPLE (Abatacept vs Adalimumab Comparison in Biologic-Naive RA Patients with Background MTX) trial showed comparable rates of remission and LDA for patients (pts) treated with subcutaneous (SC) abatacept (ABA) or adalimumab ADA). 1,2 Objectives To evaluate the relationship of radiographic outcomes with achieving LDA and remission and assess the sustainability of LDA/remission using 2-year data from the AMPLE trial. Methods AMPLE is a 2-year, Phase IIIb, randomized, investigator-blinded study. Biologic-naive pts with RA and an inadequate response to MTX were randomized to 125 mg SC ABA weekly or 40 mg SC ADA bi-weekly, with background MTX. 1 The proportions of pts achieving remission (defined as Clinical Disease Activity Index [CDAI] ≤2.8, Simplified Disease Activity Index [SDAI] ≤3.3, Routine Assessment of Pt Index Data [RAPID]3 Results 646 pts were randomized and treated with SC ABA (n=318) or ADA (n=328) on background MTX. Across all criteria for remission and LDA, most pts who achieved remission, LDA or DAS28 (CRP) scores of 85% of pts had radiographic non-progression at Year 2 (Table). Pts who achieved remission according to more stringent criteria (SDAI, CDAI, and Boolean) were more likely to be non-progressors than those who achieved LDA or DAS28 (CRP) ≤3.2. The correlation between clinical response and radiographic progression was less evident when non-progression was defined as mTSS ≤0.5 or 0. Conclusions The data demonstrate that achieving remission, LDA or DAS28 (CRP) scores of References Schiff M, et al. Ann Rheum Dis 2013;73:86-94; 2. Fleischmann R, et al. Arthitis Rheum 2013;65(Suppl 10):S209. Disclosure of Interest R. Fleischmann Grant/research support: Abbvie, Amgen, Astellas, AstraZeneca, BMS, Celgene, Dynavax, Genzyme, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB, Xoma, Consultant for: Abbvie, Amgen, AstraZeneca, BMS, Celgene, Janssen, Eli Lilly, Pfizer, Roche, Sanofi-Aventis, UCB, M. Schiff Consultant for: Bristol-Myers Squibb, Abbvie, Speakers bureau: Bristol-Myers Squibb, Abbvie, M. Weinblatt Grant/research support: BMS, Crescendo Bioscience, UCB, Consultant for: BMS, Crescendo Bioscience, UCB, Abbvie, Roche, Janssen, M. Maldonado Shareholder of: BMS, Employee of: BMS, E. Massarotti Shareholder of: Merck (Under 10,000 US dollars), Grant/research support: Investigator: BMS, Sanofi, Human Genome Sciences, J. Fay Shareholder of: BMS, Employee of: BMS, Y. Yazici Shareholder of: Samumed, Grant/research support: BMS, Genentech, Consultant for: Abbvie, BMS, Genentech, Pfizer, Samumed, UCB DOI 10.1136/annrheumdis-2014-eular.2959

Background RA is a progressively debilitating disease that decreases health-related quality of life and increases functional limitation of daily living activities. Year 1 and 2 data from the 2-year head-to-head AMPLE study showed comparable improvements and similar onset of response with subcutaneous (SC) abatacept (ABA) and adalimumab (ADA) on background MTX across multiple clinical measures and patient-reported outcomes (PROs). 1,2 It is important to understand the association between clinical responses and improvements in pain, fatigue and the ability to perform work and daily activities. Objectives To use 2-year data from the AMPLE trial to examine correlations between clinical response, including stringent remission parameters, and PROs. Methods AMPLE is a Phase IIIb, randomized, investigator-blinded study. Biologic-naive patients (pts) with RA and an inadequate response to MTX were randomized to SC 125 mg ABA weekly or 40 mg ADA bi-weekly, with background MTX. The proportions of pts achieving low disease activity (LDA; Clinical Disease Activity Index [CDAI] ≤10, Simplified Disease Activity Index [SDAI] ≤11) or remission (CDAI ≤2.8, SDAI ≤3.3, Boolean score ≤1) were assessed. PROs were analysed for pts who obtained these clinical responses at both Years 1 and 2 (“responders”) and those who did not (“non-responders”). Pain and fatigue were measured by 100-mm visual analogue scales (VAS). Work productivity was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire. The Activity Limitation Questionnaire measured the number of days pts were unable to perform usual activities during the prior 30 days. Results 646 pts were randomized and treated with SC ABA (n=318) or ADA (n=328) on background MTX. Baseline characteristics were balanced between the two treatment arms. Across multiple measures, greater improvements were observed in pain, fatigue, work time and activity in those achieving LDA or remission (Table 1). Conclusions Achievement of clinical remission and LDA was associated with greater improvements in PROs (pain, fatigue and the ability to perform work and daily activities) than pts who did not achieve clinical response. Pts treated with SC abatacept and adalimumab over 2 years had comparable responses. References Schiff M, et al. Ann Rheum Dis 2013;73:86–94, Fleischmann R, et al. Arthritis Rheum 2013;65(Suppl 10):S183. Disclosure of Interest R. Fleischmann Grant/research support: Abbvie, Amgen, Astellas, AstraZeneca, BMS, Celgene, Dynavax, Genzyme, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB, Xoma, Consultant for: Abbvie, Amgen, AstraZeneca, BMS, Celgene, Janssen, Eli Lilly, Pfizer, Roche, Sanofi-Aventis, UCB, M. Weinblatt Grant/research support: BMS, Crescendo Bioscience, UCB, Consultant for: BMS, Crescendo Bioscience, UCB, Abbvie, Roche, Janssen, M. Schiff Consultant for: Bristol-Myers Squibb, Abbvie, Speakers bureau: Bristol-Myers Squibb, Abbvie, D. Khanna Consultant for: BMS, M. Maldonado Shareholder of: BMS, Employee of: BMS, A. Nadkarni Shareholder of: BMS, Employee of: BMS, J. Fay Shareholder of: BMS, Employee of: BMS, D. Furst Grant/research support: Abbvie, Actelion, Amgen, BMS, Gilead, GSK, NIH, Novartis, Pfizer, Roche/Genentech, UCB, Consultant for: Abbvie, Actelion, Amgen, BMS, Janssen, Gilead, GSK, NIH, Novartis, Pfizer, Roche/Genentech, UCB, Speakers bureau: Abbvie, Actelion, UCB DOI 10.1136/annrheumdis-2014-eular.2113

Background Clinical remission (REM) is the treatment target in rheumatoid arthritis (RA), and there are several composite REM criteria available. Knowledge is limited on how disease duration affects REM in daily clinical practice, and whether predictors of REM depend on the method for assessment of REM. Objectives To study the rates of REM after 3 and 6 months with DMARD treatment applying different criteria, and to study predictors of REM after 6 months. Methods Data from 4992 patients in the NOR-DMARD study, representing real life rheumatology practice, were analysed. All patients started with a synthetic or biological DMARD and had 6-month follow-up data available,. Mean (SD) age was 54.6 (14.9) yrs, disease duration was 8.5 (7.9) yrs, 73.2% females. Disease duration (mean 7.9 [9.6] yrs) was grouped into: 0.5-1 yr (n=321), >1-5 yrs (n=992), >5-10 yrs (n=750), and >10 yrs (n=1532). The applied definitions for clinical REM were Disease Activity Score28 (DAS28)

Background Remission has been proposed as the therapeutic target in RA. Physical function, on the other hand, is one of the major outcomes in RA predicting work disability, health care resource utilisation and mortality. It is currently still unclear what the minimum duration of remission is that would improve functional capacity to the best possible degree. Objectives To investigate the course of functional status assessed by health assessment questionnaire (HAQ) in RA patients with sustained clinical remission (REM) for at least 6 months. Methods We were provided a random 80-90% data sample of RA patients enrolled in recent clinical trials (ASPIRE, ATTRACT, DE019, ERA, Leflunomide, PREMIER, and TEMPO; n=4362) by the respective sponsors. We identified patients, who at some point during the trials achieved REM by the Disease Activity Score using 28 joint counts and C-reactive protein (DAS28-CRP ≤2.6) or Simplified Disease Activity Index (SDAI ≤3.3), and who maintained it in all subsequent visits throughout at least 6 months.We obtained HAQ scores during these 6 month REM periods, and were thus able to investigate the course of physical function over time in sustained REM using the Wilcoxon test. In additional analyses, patients with a HAQ=0 at REM entry were excluded as they had a priori no chance to show improvement during sustained REM. Results Out of 4362 patients we identified 605 patients in sustained remission by DAS28-CRP (mean duration of REM 38.8±25.1 weeks), and 385 patients by SDAI (mean duration 37.2±23.7 weeks). There were no significant differences in baseline characteristics between these two groups. A significant decrease of HAQ over time was found over the first 6 months in REM by DAS28-CRP (mean±SD HAQ monthly from baseline to month 6: 0.25±0.4 to 0.22±0.38 to 0.22±0.39 to 0.21±0.38 to 0.20±0.37 to 0.18±0.31 to 0.16±0.32) or SDAI (0.17±0.3 to 0.16±0.32 to 0.15±0.3 to 0.14±0.29 to 0.13±0.29 to 0.13±0.26 to 0.11±0.27) with significantly (p Conclusions Functional capacity is significantly improving when remission is reached, but continues to improve if remission is sustained. The stringency of the remission criteria determines how quickly patients in remission achieve their best possible functional improvement. Disclosure of Interest H. Radner: None Declared, F. Alasti: None Declared, J. Smolen Consultant for: Abbott, Amgen, Centocor, Pfizer and Sanofi, D. Aletaha Consultant for: Abbott, Amgen, Centocor, Pfizer and Sanofi

Background We previously reported that the presence of anti-Ro/SS-A antibody (anti-Ro) was an independent factor for poor clinical response to TNF-alpha inhibitors in patients with rheumatoid arthritis (RA). Objectives To investigate factors associated with normalized physical function, and clinical remission determined by simplified disease activity index (SDAI) at 54 weeks of infliximab (IFX) treatment in patients with RA. Methods We studied 114 patients with RA treated with IFX, and prospectively examined SDAI, Disease Activity Score in 28 joints (DAS28)/CRP, and modified Health Assessment Questionnaire Disability Index (mHAQ-DI). The clinical remission was defined with simplified disease activity index (SDAI) ≤3.3, and normal physical function was defined by mHAQ-DI Results Among 114 patients, 20 patients were withdrawn from this study because they had discontinued by 54 weeks (one was infection, one was reaction of allergy, and others were stopped IFX because of no efficacy). Age, gender, duration, SDAI and DAS28 at baseline were 50.14±13.15, 79 female/15male, 9.40±7.98, 4.19±1.14, and 25.43±12.78, respectively. In 94 patients, 17 (18.1%) and 33 (35.1%) were achieved remission defined with SDAI and DAS28/CRP, respectively. Normalized physical function, mHAQ Conclusions The prevalence of secondary SS and the presence of anti-Ro/SS-A antibodies before IFX treatment might associate with the outcome of poor physical function. To attain SDAI remission and normal physical function, tight control is necessary to prevent irreversible physical dysfunction. Disclosure of Interest None Declared

Objectives To compare the efficacy of adalimumab, etanercept, and infliximab therapy in psoriatic arthritis (PsA) patients with oligoarticular or polyarticular subset Methods We enrolled in a prospective, not-randomized, open-label study 349 PsA patients with peripheral disease, 234 with polyarticular and 115 with oligoarticular subset, beginning a treatment with adalimumab, etanercept, or infliximab. At baseline, 6 months, and 12 months, disease activity indices, (DAS28, Disease Activity Score on 28 joints, SDAI, simplified disease activity index, sum of TJC tender joint count, SJC swollen joint count, CRP C-reactive protein, and PzGA Patient Global Assessment), and disability HAQ (Health Assessment Questionnaire) were calculated. The rates of disease remission were compared among the three TNF-ablockers at 6 and 12 months. Baseline predictors of disease remission and functional improvement (reduction of HAQ ≥0.5) were analyzed by multivariate regression models Results After 12 months the percentage of patients on clinical remission (SDAI ≤3.3) was significantly higher in infliximab or etanercept than adalimumab group (p Conclusions Our study provides evidence that anti-TNFa drugs may differently perform in PsA and that separate analysis of the clinical subsets of the disease may improve our knowledge of the management of PsA Disclosure of Interest None Declared

Background The activity of rheumatoid arthritis (RA) is evaluated with many clinical criteria such as DAS (disease activity score), SDAI (simplified disease activity index), CDAI (clinical disease activity), and Boolean method. With these criteria, it has become convenient to evaluate the patient’s state and the efficacy of treatment for RA. However, the subjective data such as patient global assessment have sometimes no connection to the objective data. Objectives The purpose is to evaluate the each clinical scale to find the difference of clinical efficacy, and to find main factor that causes the discrepancy of the criteria from clinical state of the patients. Methods We retrospectively evaluated 421 patients with RA, who had been followed in our division in August 2012, with clinical criteria such as DAS28ESR, DAS28CRP, SDAI, CDAI, and Boolean method (trial and practice). The ratio of male to female was 83:338, and the average age was 64.4±13.5 (17.2-91.9) years old. The average follow-up periods in our division was 8.4±5.5 (0.2-29.0) years. Results Methotrexate and biologics were administered in 301 (71.5%) and 148 (35.2%) patients, respectively. Steroid was used in 164 patients (39.0%). Three hundreds twenty-seven patients (77.7%) were achieved to clinical remission with one of these criteria, whereas 103 patients (24.2%) were satisfied with all criteria for clinical remission. The ratio of clinical remission was much with DAS28CRP (67.2%), and little with Boolean trail (28.3%). Although more than 90% of patients showed low disease activity with SDAI and CDAI, only 69.3% patients were satisfied with low disease activity by DAS28ESR. The main factors not to satisfy clinical remission were patient’s global assessment for all criteria, and ESR for DAS28ESR. Patient’s visual analogue scales were not often reflected with their real clinical assessment by their words. As ESR was also reflected with anemia and hyper-gammaglobulinemia, it was not always useful to evaluate the inflammation of RA. The many patients with high disease activity had high score of tender joints count and patient global assessment without inflammation. Conclusions Because of the progression of treatment for RA, many patients were achieved to the clinical remission or low disease activity in real world. The patients who showed high disease activity were mainly occupied with those who had destructive joints damage without inflammation. Also, it should be very careful to judge the patients’ clinical state when the clinical remission criteria would not be satisfied because of the failure due to only the subjective marker. Disclosure of Interest None Declared

Background Tocilizumab (TCZ) is a humanized anti-interleukin 6 receptor (IL-6R) monoclonal antibody and it was approved in Japan as an antirheumatic drugs in 2008. Evidence of the efficacy of TCZ in real-world RA patients is still few as compared with tumour necrosis factor (TNF) inhibitors. Objectives We have tried to evaluate the efficacy of TCZ in patients with RA during the 3 years after an approval in 2008 at Nagasaki prefecture, Japan. Methods One hundred fifty-two RA patients at Nagasaki prefecture, Japan, who has received 8 mg/kg of TCZ every 4 weeks during 3 years, were consecutively enrolled in this study. Ninety-nine patients had evaluable data for 1 year at present. We have focused on the efficacy of TCZ in the present study trying to evaluate the clinical response of disease activity score (DAS) 28, simplified disease activity index (SDAI), clinical disease activity index (CDAI), Boolean approach and Health Assessment Questionnaire (HAQ) by last observation carried forward (LOCF) methodology toward these 99 patients, respectively. Results The mean age, disease duration and clinical disease activity at baseline were 58 years-old, 11 years, DAS28-ESR: 5.5, SDAI: 28.7 and CDAI: 25.5, respectively. Fifty-nine percent of the patients had received TNF inhibitors before introduction of TCZ. Although most of the patients were active as well as established disease at baseline, the continuation rate at 1 year was superior as 81.1%. A rate of clinical remission at 1 year of DAS28-ESR, SDAI, CDAI and Boolean-based definition was 49.5%, 17.2%, 13.1% and 13.1%, respectively. There was a clear relation of the rate of clinical remission with shorter disease duration (less than 2 years) or no previous history of TNF inhibitors. Furthermore, low HAQ at baseline was the only variable to be associated with CDAI remission (OR [95% CI]: 0.34 [0.09-0.88], p=0.06) and HAQ remission (OR [95% CI]: 0.17 [0.03-0.50], p Conclusions The present study shows an excellent therapeutic efficacy as well as the characterisitic of patients being achieved in remission by TCZ in the real-world clinical practice. References Kawashiri SY, et al. In rheumatoid arthritis patients treated with tocilizumab, the rate of clinical disease activity index (CDAI) remission at 24 weeks is superior in those with higher titers of IgM-rheumatoid factor at baseline. Mod Rheumatol. 2011;21:370-4. Kawashiri SY, et al. Disease activity score 28 may overestimate the remission induction of rheumatoid arthritis patients treated with tocilizumab: comparison with the remission by the clinical disease activity index. Mod Rheumatol. 2011;21:365-9. Disclosure of Interest None Declared

Background Treat to Target (T2T) is the main strategy for the treatment of rheumatoid arthritis (RA). We need to control disease activity in order to sustain ADL in optimal status and minimize joint destructive risk for each patient. Objectives To clarify how disease activity and joint destruction affect on Health Assessment Questionnaire (HAQ), the relationship between Simplified Disease Activity Index (SDAI), HAQ, and disease progression is investigated. Methods For every RA patients attending to our institute, we have been calculating SDAI and HAQ since August 2010. Our treatment protocol for RA was programmed according to T2T recommendation. Patients have counted 351 until October 2011, and total measured times was 2857 times. After excluding patients who were treated with biologic agents and patients who attended less than five times, 202 patients has been counted throughout one year follow up. Steinbrocker’s stage classification based on X-ray pictures has been made every year. According to the criteria, patients were classified as 86 patients of Stage1, 54 of Stage2, 34 of Stage3, and 28 of Stage4. Average SDAI, probability of SDAI remission and low disease activity (LDA) (C-ratio), relationship between SDAI and HAQ, were evaluated and compared for each stage group statistically. HAQ obtained at the time of SDAI remission (B-HAQ) for each patient is also compared for each group. Maximum and minimum SDAI and HAQ at the time for each patient were picked up for the comparison of HAQ difference between active and controlled phase of the RA. The average HAQ value (A-HAQ) for each group was also compared statistically. Linear regression among HAQ, SDAI, and Stage is also evaluated statistically. At last, average HAQ at the time of remission, and at the time of no remission (D-HAQ) are compared for each group statistically. Results In 2323 times of measurement, there were 932 times of Stage1, 605 of Stage2, 398 of Stage3, and 380 of Stage4. No patient whose stage had changed in the followed term has shown. Average SDAI of smaller stage showed significant difference than any of other larger stage (p Conclusions These results supported T2T strategy. As stage progress, disease activity control becomes difficult, and ADL limitation increases. Disease control is easier in early stage. And as disease activity is controlled tightly, ADL remission becomes more sustainable. ADL is influenced both by disease activity and by stage progression. However, effect of activity control is getting smaller as stage progress. As stage progress, HAQ management becomes difficult as well as activity management. In Stage4, even patients can attain SDAI remission, HAQ showed no improvement. Therefore we should control RA activity tightly and sustain clinical remission status as tightly as possible in early stage. Disclosure of Interest None Declared

Background An essential element in the treat to target strategy is modification of treatment in the absence of achieving a target response by 12 weeks. A change in the Disease Activity Score (DAS28 ESR) of 1.2 and Simplified Disease Activity Index (SDAI) of 50% (SDAI50 based on a ACR20) are possible response measures (RM). Objectives To characterize patients (pts) failing to respond to either RM and determine a relationship between the two. Methods The study was carried out on the Canadian Early Arthritis Cohort (CATCH) - a multicentre early arthritis RA cohort comprising 1953 pts with disease of Results The cohort comprised 74.9% females, mean age: 52.6 years, mean disease duration: 5.7 months. Baseline (BSL) disease characteristics included a mean tender joint count: 9.0, swollen joint count: 8.2, DAS28: 5.2, HAQ: 1.1, SDAI: 29.7, ESR: 27.2, and CRP: 14.4. Of 419 pts evaluated, 198 pts failed to achieve a DAS28 1.2 and 206 pts failed to achieve a SDAI50 by 12 weeks. A strong relationship was observed between DAS28 1.2 and SDAI50 non-responders (Kappa 0.66) and Spearman Correlation (0.66) (p Conclusions SDAI50 and DAS28 1.2 RM are well correlated although at high disease states the likelihood of achieving an SDAI50 is lower than achieving a DAS28 1.2, while the reverse is true at lower disease states. Disclosure of Interest M. Omair: None Declared, P. Akhavan: None Declared, E. Keystone: None Declared, J. Xiong: None Declared, G. Boire: None Declared, J. Pope: None Declared, J. Thorne: None Declared, C. Hitchon: None Declared, B. Haraoui: None Declared, D. Tin: None Declared, D. Weber: None Declared, V. Bykerk Grant/research support from: The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. via an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoffman-LaRoche Limited, United Chemicals of Belgium (UCB Canada Inc.)., Bristol-Meyers Squibb Canada Co., Abbvie Inc., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).

Background The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria (Boolean criteria) for rheumatoid arthritis (RA) is one of popular index for remission. This index is well known, but not being used even for rheumatologist, because of lack of regularity in patient’s global assessment (PGA), which is a part of the core set in Boolean criteria([1][1]). Objectives To evaluate near miss of Boolean criteria what means fulfilling three of the four Boolean criteria parameters in clinical practice. Methods Since August 2010, we have been treated RA with identical protocol according to T2T recommendations. Five thousand times from 384 RA patients have had chance to measure RA disease activity index such as clinical disease activity index (CDAI), simplified disease activity index (SDAI), Boolean criteria, pain score (PS), and health assessment questionnaire (HAQ-DI). From these indices, Boolean criteria, SDAI, PS, and HAQ-DI were used in this study. Three parameters without PGA fulfilled in Boolean criteria and remission were picked up. These evaluations were qualified as SDAI criteria at each measured time. Distribution of SDAI evaluation criteria was calculated. Measured evaluation was classified into groups according to PGA increment with 1.0 on scale. SDAI remission probability, sensitivity and specificity for SDAI remission were calculated for each division. Average SDAI, average PS, and average HAQ-DI were also calculated for each division, and evaluated with linear regression analysis. Results SDAI remission probability for each PGA division was 1.0, 0.97, 0.88, 0.55, 0.67, 0.51, and 0.49, while sensitivity for SDAI remission was 1.0, 0.9981, 0.9842, 0.9671, 0.9437, 0.9353, 0.9194, and specificity was 0.5051, 0.5556, 0.6907, 0.7214, 0.8659, 0.9048, 1.0 for 0, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0 in PGA scale division, respectively. PGA was closely correlated with all of SDAI, PS and HAQ-DI significantly, while regression formula was y=0.5765x + 0.155 (R=0.99283), y=4.522x - 2.3955 (R=0.98530), and y=0.6611x – 0.0463 (R=0.84253), respectively. Conclusions These results suggested that PGA in near misses of Boolean criteria reflects disease activity level very strongly. If PGA is within 2.5, both of sensitivity and specificity for SDAI remission demonstrated more than 90%. PGA is also closely related with pain and ADL. We should make consideration to use Boolean criteria with alternative utility. References 1. Studenic P., et al., Ann Rheum Dis 2012;69:1702-1705 Disclosure of Interest None Declared [1]: #p-7

Background Better outcomes are achieved by using a “tight” control strategy to treat rheumatoid arthritis (RA), but this approach has not yet been explored in resource-contrained sub-Saharan Africa. Utilizing the Clinical Disease Activity Index (CDAI) score, thus obviating the need for acute phase reactant measurement, may be a resource-sparing approach. Objectives We prospectively compared the disease control with a tight control strategy utilising either the Simplified Disease Activity Index (SDAI) or the CDAI. Methods In a 26-week study, 97 DMARD-naive RA patients attending Chris Hani Baragwanath Hospital in 2011-12, were randomised to either an SDAI or CDAI arm and treated with traditional DMARDs, escalated on a monthly basis according to pre-defined protocol to achieve low disease activity (LDA). The primary outcome was the number of patients achieving at least LDA in both arms as by the DAS28. Additionally, the outcomes of entire cohort were compared to a cohort of 145 early RA patients attending the same hospital between 2005 and 2009 and treated with traditional DMARDs according to routine care[1][1]. No patients received biologic therapy. Results The two arms were well-matched for disease activity and symptom duration at baseline (see table). At 26 weeks, neither the mean DAS28 score nor the proportion of patients achieving LDA was signficantly different beween the CDAI and SDAI groups. All patients received low dose prednisone (7.5mg daily) and at 26 weeks the mean methotrexate (MTX) dose was 20.8mg/week. Compared to the historical cohort treated with routine care, patients in the present study achieved a significantly lower mean DAS28, despite a signficantly longer symptom duration before commencement of DMARDs. Remission was achieved in 29% of patients treated by tight control, compared to 8% in the routine care group (p

Background As the opportunities for web-based self management, support and clinical decision-making across chronic diseases increase, there is an urgent need to explore reliable means of eliciting self-reported symptoms and disease activity scores from patients with rheumatoid arthritis (RA) (1). A patient derived Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) based on self-report joint count, if reliable, could serve as an important marker of disease activity in RA. The reliability of patient self-assessment of tender and swollen joints has been examined (2), but the reliability of patient-derived scores seems to have escaped much attention. Objectives To examine the test-retest reliability of the DAS28-CRP with three and four variables, the SDAI and the CDAI when based on patient self-assessment of tender and swollen joints, and to assess the agreement of these scores with corresponding physician derived scores in patients with RA. Methods 30 out-clinic RA patients with stable disease were included. A joint count was performed by the patient and by an experienced physician at two visits 1 week apart. Test-retest reliability was expressed as the least significant difference (LSD = 1.96 x SD of test-retest differences), as the LSD in percent of the mean of the score (%LSD) which may be considered as the measurement error and as intra-individual coefficients of variation (CV i ) = (√0.5x d i 2 ) /mean i (3-5). Results Mean age was 60±15 years, mean disease duration 15±6 years. 77% were females, 75% were erosive and 70% were sero-positive. Mean values (±SD) (visit 1) was 4.1±5.2 for TJC, 3.7±2.4 for SJC, 33±28 (0-100) for patient global assessment (GA), 22.3±21.8 (0-100) for physician GA and 7.9±6.5 for CRP (mg/l). The means of correspondingphysician and patient derived s cores were nearly identical. The LSDs (%LSD) between physician and patient derived scores (visit 1) were: DAS28-CRP(4v) 0.9 (24.9), DAS28-CRP(3v) 1.0(27.8), SDAI 7.3 (51.3) and CDAI 7.3 (54.3). Similar results were found for duplicate physician and patient-derived scores. CV i s for patient and physician derived scores were not significantly different for neither DAS28-CRP(3), DAS28-CRP(4), SDAI nor CDAI. CV i s for SDAI and CDAI were similar but were significantly higher than for DAS28-CRP(3) and DAS28-CRP(4) (p Conclusions Disease activity scores based on patient and physician reported joint counts agreed closely on group level. On the individual level, LSDs between patient and physician derived scores were considerable but corresponded to both patient and physician intra-observer LSDs. Thus, scores based on patient-performed joint counts may be an alternative to traditional physician-derived scores in patients with stable disease. More studies are needed to examine the value of patient self-assessment of disease activity scores. References Barton JL et al. J Rheumatol 2009;36:2635-41. 2) Solomon M et al. J Med Internet Res 2012;14:e32. 3) Bland JM, Altman DG. Lancet 1986;1:307-10. 4) Gluer CC et al. Osteoporos Int 1995;5:262-70. 5. Madsen OR. Spine 1996 21:2770-6. Disclosure of Interest None Declared