SAT0079 Treatment expectations influence both subjective and objective outcome parameters in patients with rheumatoid arthritis- a prospective cohort study

Background The prediction of individual response to treatment in rheumatoid arthritis (RA) is challenging and often limited. Here we evaluate the influence of patients’ expectations and attitudes towards newly initiated disease-modifying anti-rheumatic drugs (DMARDs) on clinical outcome in RA. Methods 100 patients (74 female) with RA according to 2010 ACR/EULAR classification criteria with upcoming change in DMARD treatment were included. Patients’ treatment beliefs, health related quality of life, treatment expectations, and pain-related cognitions were measured using the beliefs about medicines questionnaire (BMQ), the SF-36, the questionnaire about patient expectation (PE), and the pain-related self-statement scale (PRSS), respectively before treatment initiation (T0) and their DAS28-CRP was calculated at T0 and after 4 months (T4). Associations between patients’ beliefs, expectations and their attitude according to the questionnaires and changes in DAS28-CRP between T0 and T4 were explored by regression analyses using the Aikaike information criterion. Results Regression analyses revealed that 42.2% of all variability in treatment response measured as a decline in DAS28-CRP (ΔDAS28) could be explained by expectations, psychological factors and laboratory parameters assessed with the applied questionnaires. Among these we identified the expected improvement rate with 23.4% as well as the patients’ fear of side effects with 22.0% as the main predictors of ΔDAS28. The CRP-value at T0 accounted with 15% to the variability in ΔDAS28. Other highly influential factors were PRSS catastrophizing scale (10.7%), the BMQ concern scale (8.1%), other BMQ scales (7.9%) and medications’ route of administration (8.0%). Conclusions The present study indicates a high impact of patients’ expectations and their attitude towards new therapies on clinical response effecting both objective and subjective outcome parameters. Integration of individual patient’s preferences and their expectations in treatment decisions and management can significantly increase treatment response. Disclosure of Interest None declared