POS0163 ANXIETY AT 3 MONTHS IS ASSOCIATED WITH WORSE DISEASE ACTIVITY, PROs, AND PREDICTS PROGRESSION TO ADVANCED THERAPIES BY 12 MONTHS IN EARLY RA: RESULTS FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH)

Background: Pain, fatigue, depression and anxiety commonly co-occur in patients with RA and impact disease activity assessments, PROs, and treatment adherence and outcomes. Little is known about the extent to which these symptoms may contribute to progression to advanced therapies in early RA. Objectives: To compare the likelihood of escalation to advanced therapies (i.e., biologics and JAKis) by 12 and 24 months by symptom status (pain, fatigue, anxiety, and depression) at diagnosis and after initial methotrexate treatment (3 months) in new RA patients. Methods: Data were from newly diagnosed RA patients (symptoms < 1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) between Jan 2017-Aug 2022 with active disease and MTX monotherapy or MTX with a csDMARD combination. Participants underwent standardized clinical assessments and completed PROMIS-29 at 0 and 3 months. Anxiety, depression, fatigue and pain interference were defined as PROMIS ≥ 55 vs. <55 and groups were compared by symptom status. Separate multivariable logistic regression models and ROC curves for baseline and 3 months (post initial treatment) were constructed adjusting for CDAI, age, sex, race, education, smoking status, obesity, comorbidities, serology status and symptom duration. Results: The 255 adults had a mean (SD) age of 56 (14), and were mostly female (69%), White (78%) with a CDAI of 30 (14) at diagnosis. All started similar MTX regimens (monotherapy [55%] or with csDMARDs [45%]). At 3 months, mean CDAI had fallen substantially in both groups; a higher proportion of patients (n=151; 59%) were classified as anxious than at baseline. A total of 102 (40%) reported no anxiety at either time point, 76 (30%) were anxious at both 0 and 3 months; as compared with baseline, 28 (11%) reported new anxiety while 49 (19%) were no longer anxious at 3 months. Mean Pain Interference, Fatigue, Anxiety and Depression scores were 8-15 points higher in anxious vs. non-anxious patients. By 12 months, more than twice as many patients who were anxious at 3 months (vs. non-anxious) were on advanced therapies at 12 months (15% vs. 7%); a similar trend was observed at 24 months (18% vs. 10%). However, rates of advanced therapy use did not differ significantly by pain interference, fatigue, or depression status at 3 months. The optimal multivariable model for predicting advanced therapy use by 12 months included Anxiety status and CDAI at 3 months after adjustment for age, sex, race, education, smoking status, obesity, comorbidities, serology status and symptom duration (Figure 1b; ROC 0.84 vs. 0.73 at baseline). Patients who were anxious at 3 months had 5.1 the odds (95% CI 1.4, 18.2) of being on an advanced therapy at 1 year, with a similar trend at 24 months (OR 3.0; 95% CI 1.1, 8.2). In contrast, Depression, Pain interference, and Fatigue status at 3 months were not associated with a greater likelihood of progression to an advanced therapy by 12 and 24 months (data not shown). At baseline, the 138 (49%) who reported anxiety at 3 months were on average significantly (p<.01) younger and had higher patient global scores (Table 1). Conclusion: In this large real world longitudinal cohort of new RA patients, almost half reported anxiety at baseline, increasing to 59% by 3 months, even after a robust response to initial MTX treatment. A novel finding is that patients with anxiety at 3 months (but not depression, fatigue, or pain interference) had worse CDAI disease activity and patient reported outcomes and >5 fold increase in the odds of being on an advanced therapy by 1 year. Anxious patients may be more likely to advocate for a change of treatment including advanced therapies; anxiety may also reflect greater impact of social determinants of health. Better understanding of anxiety in early RA may offer new opportunities to improve QOL and support treatment decision making. REFERENCES: NIL . Figure 1 Table 1Characteristics of new RA Patients by anxiety status at 3 months.*Mean (SD), Mdn (IQR), or N (%)Anxiety104 (41%)No Anxiety151 (59%)SIGBaselineAge (years)53 (15)58 (14)0.01Women (%)79 (76%)98 (65%)0.06TJC-28 mdn (IQR)9 (5, 11)10 (5, 13)0.09SJC-28 mdn (IQR)7 (4, 10)8 (4, 13)0.06MD Global5.9 (2.1)6.0 (2.1)0.85Patient Global5.9 (2.4)5.0 (2.7)0.01Stiffness (0-10)6.6 (2.5)6.2 (2.6)0.21CDAI28.5 (12.9)30.8 (13.9)0.19PROMIS Anxiety59.8 (9.4)49.9 (9.0)<0.0013 MonthsTJC-28 mdn (IQR)3 (1, 7)2 (0, 5)0.06SJC-28 mdn (IQR)1 (0, 5)2 (0, 5)0.43MD Global2.7 (2.3)2.6 (2.3)0.75Patient Global4.7 (2.3)2.5 (2.2)<0.001Stiffness (0-10)4.7 (2.6)3.0 (2.3)<0.001CDAI15.1 (11.0)12.2 (11.5)0.04PROMIS Anxiety60.9 (5.1)44.3 (5.1)<0.001Advanced Therapy at 12 months16 (15%)10 (7%)0.02Advanced Therapy at 24 months19 (18%)15 (10%)0.05*PROMIS Anxiety 4a score ≥ 55 (post initial MTX treatment). Acknowledgements: On behalf of Canadian Early Arthritis Cohort investigators and participants. Disclosure of Interests: Susan J. Bartlett Janssen, Sanofi, Pfizer, Organon, Sanofi, Clifton O Bingham Abbvie, Eli Lilly Janssen, Pfizer, Sanofi, Marie-France Valois: None declared, Janet Pope AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Certa, Eli Lilly, Frensenius Kabi, Janssen, Nordic Pharma, Novartis, Organon, Otsuka, Palleon, Pfizer, Sandoz, Sanofi, UCB, Zura DSMB: Astra Zeneca, Horizon, Novartis, AbbVie, Amgen, Astra Zeneca, Boehringer Ingelheim, Boxer Capital, Bristol Myers Squibb, Celltrion Healthcare, Eli Lilly, Frensenius Kabi, GSK, Janssen, Merck, Novartis, Pfizer, Sandoz, Sanofi, BMS, Janssen, Mallinckrodt, Pfizer (Seattle Genetics), Hugues Allard-Chamard Abbvie, UCB, AstraZeneca, Abbvie, Amgen, Astrazeneca, BMS, Celltrion, Eli Lilly, Hoffmann-La Roche, Fresenius Kabi, GSK, Janssen Novartis, Mantra Pharma, Otsuka, Pfizer, Sandoz, Sobi, AstraZeneca, Abbvie, Amgen, Astrazeneca, BMS, Celltrion, Eli Lilly, GSK, Hoffmann-La Roche, Janssen, Novartis, Otsuka, Sandoz, Pfizer, Sobi, AstraZeneca, Eli Lilly, Fresenius Kabi, Pfizer, Louis Bessette Amgen, BMS, Janssen, UCB, Abbvie, Pfizer, Lilly, Novartis, Sanofi, TEVA, Fresenius Kabi, Sandoz, JAMP Pharma, Organon, Amgen, BMS, Janssen, UCB, Abbvie, Pfizer, Celgene, Lilly, Novartis, Sanofi, TEVA, Fresenius Kabi, Sandoz, Organon, Sobi, Amgen, BMS, Janssen, UCB, Abbvie, Pfizer, Celgene, Sanofi, Lilly, Novartis, AstraZeneca, JAMP Pharma, Gilles Boire Orimed Pharma, Viatris, Abbvie, Janssen, Lilly, Mylan, Novartis, Pfizer, Sanofi, Teva, Viatris, BMS, Biocon, Pfizer, Glen Hazlewood: None declared, Carol A Hitchon Sandoz, Pfizer, Astra Zeneca, Bindee Kuriya Abbvie, Abbvie, UCB, Pfizer, Carter Thorne Medexus, Accord, Abbvie, Janssen, Lilly, Mylan, Novartis, Pfizer, Sanofi, Teva, Viatris, JAMP, Pfizer, Vivian Bykerk: None declared. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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