THU0276 ANALYSIS AT ONE YEAR OF AN INCEPTION COHORT OF EARLY RHEUMATOID ARTHRITIS (RA): THE SONORA STUDY
M Weisman, C Bombardier, E Massarotti, P Gregersen, C Formica, and R Deaton

THU0278 DISCREPANCIES IN PHYSICIAN-REPORTED VERSUS PATIENT-REPORTED MEASURES OF DISEASE ACTIVITY I NEW ONSET RHEUMATOID ARTHRITIS
M Weisman, C Bombardier, E Massarotti, P Gregersen, R Deaton, and C Formica

THU0279 CLINICAL MARKERS OF DISEASE PROGRESSION IN THE SONORA COHORT: EFFECTS OF RHEUMATOID ARTHRITIS AND SMOKING HISTORY
E Massarotti, P Gregersen, C Bombardier, M Weisman, C Formica, and R Deaton

These three abstracts report early findings from the SONORA Study. The SONORA (Study of New-Onset RA) cohort consists of patients with early rheumatoid arthritis (> 3 but < 12 months disease duration) from 98 Rheumatology clinics across North America. Certified Rheumatologists diagnosed the patients. The purpose of this 5-year observational cohort is to assess the clinical, biological, epidemiological, and sociological factors affecting disease progression. Of 1012 currently enrolled, a complete year of data is available for 388 patients. The following three summarized abstracts include data on patterns and outcomes of DMARD use (THU0276), patient/physician differences in reporting disease status (THU0278), and effects of smoking history (THU0279).

Methods: After baseline assessment, patients had clinical and laboratory workups at 1, 2, & 5 years and completed validated questionnaires every 4 months.

Results: At baseline, 67% of patients were receiving DMARD therapy; this percent increased to 88% by one year. Of those on DMARDs, 59% were taking methotrexate at baseline, increasing to 69% at year 1. Only 2% were on anti-TNF therapy at baseline, but 12% used biologic agents during year 1. 80% of patients on etanercept and infliximab were on concomitant methotrexate. Hydroxychloroquine use was high, 41% and 43% at baseline and year 1 respectively.

By one year, 37%, 19%, and 6% of patients achieved ACR 20, ACR 50, and ACR 70, respectively. Mean tender joint counts fell from 17.2 to 9.0 over the year, while mean swollen joint counts fell from 12.4 to 6.9. The mean improvement in patient global assessment of disease activity was lower when reported from home (.66 units) than when reported at the study visit (1.13 units). Additionally, physician assessments correlated with patient assessments more when done in the office (R=0.43) than those done in the home (R=0.28). However, patient assessments of pain done in the physician office and in the home were comparable (R=0.49). Correlations between patients and physicians in tender and swollen joint counts were modest, R=0.36 and R=0.24, respectively.

When smoking status is considered, ACR 20 response is achieved more often by females who never smoked (42%) than by females who currently smoke (24%). This difference was not observed in males. Of patients aged < 65 years, 46% of patients who never smoked achieved ACR 20 response compared with 28% who currently smoke. Smoking status did not affect ACR 50 response. ACR 20 response was also achieved more often in RF negative patients who were former smokers (46%) than in RF negative patients who currently smoke (17%). Although trends were found in other comparisons, none reached statistical significance (p<0.05).

Conclusion: In summary:

• 88% of patients have received DMARD therapy in the first year, the major DMARD of choice being methotrexate.
• There are discrepancies in patients global assessments of disease activity between reports made in the physicians office and reports made in the home.
• Current smoking status may mildly lower a patients likelihood of achieving an ACR 20 response.

Editorial Comment: When complete, this study will help to provide important information on predictors of disease progression and response to DMARDs. The early data presented here is not surprising and is consistent with information from other studies. We look forward to future findings.

All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.