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Durch erhebliche versorgungsstrukturelle Defizite wird die Notwendigkeit einer moglichst fruhen Diagnose und Therapieeinleitung bei Rheumatoider Arthritis (RA) von der Mehrheit der Patienten in Deutschland verpasst. Die Herausforderung ist, den individuellen Anspruch eines bestmoglichen Therapieergebnisses mit einem gesellschaftlich tragfahigen Mittelaufwand in Einklang zu bringen. Das transsektorale Versorgungsnetzwerk ADAPTHERA zielt darauf ab, die fruhe RA-Diagnose und Behandlung in Rheinland-Pfalz zu verbessern. Fur die retrospektive Triage Analyse wurden 1045 Anfragen nachverfolgt. Zur Auswertung des klinischen Verlaufs wurde eine 143 Patienten umfassende Subkohorte analysiert. Quartalsweise wurden klinische und laborchemische Routineparameter erfasst, eine Batterie an Fragebogen ausgefullt und das therapeutische Regime bei Bedarf angepasst. Insgesamt konnten 454 Patienten eingeschlossen werden. Die mittlere Wartezeit betrug 23,9 (SD = 18) Tage. Der mittlere Beobachtungszeitraum in der Subkohorte lag bei 29,2 (SD = 12,7) Monaten, wobei die Halfte der Patienten binnen 3 Monaten vorstellig wurde. Fast 75 % der Patienten befanden sich nach 2 Jahren in Remission. Eine nachhaltige Remission konnte fur 74,8 % (6 Monate) respektive 53,5 % (12 Monate) beschrieben werden. Besonders Patienten mit rascher Remissionsinduktion profitierten im Sinne langerer Remissionen (p = 0,03). Ein sehr fruhes Krankheitsstadium (VERA) war mit einer seltener notwendigen Biologikatherapie assoziiert (p = 0,022). Der Ansatz eines Versorgungsnetzwerkes ist kein Allheilmittel, es kann aber eine deutliche Verbesserung der Versorgung bewirken. Kernpunkt zur Minimierung der kapazitaren Auslastung ist dabei eine moglichst zielgenaue Zuweisung und eine akkurate Triage.

BACKGROUND AND OBJECTIVE For patients with established rheumatoid arthritis and also early arthritis an increased prevalence of depression has been described. For a better understanding of depression in early arthritis patients, depression prevalences of a German early arthritis cohort were examined, with a focus on disease activity, anti-CCP status, disease duration and functional capacity over a period of 2 years. MATERIAL AND METHODS The evaluation was based on the early arthritis cohort ADAPTHERA from Rhineland-Palatinate. The inclusion criterion was a symptom duration before diagnosis of a maximum of 1 year. Data from the disease activity score 28 (DAS28), the Health Assessment Questionnaire (HAQ, functional status), the WHO-5 Well-Being Index (WHO-5, well-being and depressive symptoms) and the Patient Health Questionnaire-9 (PHQ-9, depressive symptoms) were collected. RESULTS At the beginning, 43.5% of patients had depressive symptoms (WHO-5 > 28). After the 2 year follow-up the percentage of patients with depressive symptoms had reduced to 20.8%. Correlations with disease activity according to DAS28 and the function of HAQ could be confirmed. There was no correlation between depressive symptoms and anti-CCP status (p = 0.431) or duration from symptom onset to diagnosis (p = 0.671). CONCLUSION Screening of early arthritis patients for the presence of depressive symptoms is of essential importance. Patients seem to be at high risk of developing depressive symptoms especially at the beginning of the disease and when showing high disability and poor results on disease activity score (DAS28 and visual analog scale).

The majority of patients in Germany miss out on the necessity of early diagnosis and initiation of therapy for rheumatoid arthritis (RA) caused by considerable structural deficits in the health care system. The challenge is to reconcile the individual demand for the best possible therapy result with a sustainable expenditure of resources.The cross-sectoral regional care network ADAPTHERA aims to improve early RA diagnosis and treatment in Rhineland-Palatinate. The retrospective triage analyses of suspected early onset RA patients was performed by tracing the selection process of all available enquiries (n = 1045). For analysis of the clinical course of the disease, a subset comprising 143 patients with a minimum observation time of 12 months (5 consecutive visits) was available. Clinical and laboratory parameters were collected quarter yearly, self-administered questionnaires were filled out and the treatment was adapted if necessary.A total of 454 patients were included. The mean waiting time was 23.9 (SD = 18) days. The mean observation period in the subcohort was 29.2 (SD = 12.7) months, with about 50% of the patients presenting within 3 months. Almost 75% of the patients were in remission after 2 years. A sustained remission could be described for 74.8% (6 months) and 53.5% (12 months), respectively. Especially patients with rapid remission induction benefited in terms of longer remissions (p = 0.03). A very early stage of the disease (VERA) was associated with a rarely necessary biologic therapy (p = 0.022).The approach of a supply network is not a panacea, but it might improve healthcare for patients with early onset RA. In order to minimize resource utilization, a pinpoint referral and accurate triage of potential cases are crucial.

For patients with established rheumatoid arthritis and also early arthritis an increased prevalence of depression has been described. For a better understanding of depression in early arthritis patients, depression prevalences of a German early arthritis cohort were examined, with a focus on disease activity, anti-CCP status, disease duration and functional capacity over a period of 2 years.The evaluation was based on the early arthritis cohort ADAPTHERA from Rhineland-Palatinate. The inclusion criterion was a symptom duration before diagnosis of a maximum of 1 year. Data from the disease activity score 28 (DAS28), the Health Assessment Questionnaire (HAQ, functional status), the WHO-5 Well-Being Index (WHO-5, well-being and depressive symptoms) and the Patient Health Questionnaire-9 (PHQ-9, depressive symptoms) were collected.At the beginning, 43.5% of patients had depressive symptoms (WHO-5 28). After the 2 year follow-up the percentage of patients with depressive symptoms had reduced to 20.8%. Correlations with disease activity according to DAS28 and the function of HAQ could be confirmed. There was no correlation between depressive symptoms and anti-CCP status (p = 0.431) or duration from symptom onset to diagnosis (p = 0.671).Screening of early arthritis patients for the presence of depressive symptoms is of essential importance. Patients seem to be at high risk of developing depressive symptoms especially at the beginning of the disease and when showing high disability and poor results on disease activity score (DAS28 and visual analog scale).

Background The significance of early diagnosis and early therapy initiation in patients with RA is tremendous. ADAPTHERA is a state wide rheumatology network based in Rhineland-Palatinate, Germany. ADAPTHERA aims to improve RA prognosis and quality of patients` life by reducing the time-to-RA-diagnosis. While there have been a lot of studies regarding quality of life in patients with established RA 1,2 , adequate data concerning very early rheumatoid arthritis (VERA) (disease duration Objectives To study quality of life in VERA patients and to investigate its associations with various RA associated clinical and laboratory parameters. Methods In a two center subgroup analysis from the ADAPTHERA cohort, we studied quality of life indexes such as Hannover Functional Ability Questionnaire (HFAQ), Health Assessment Questionnaire (HAQ), EuroQol-5D-3L (EQ-5D-3L), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) and World Health Organisation-5 Well Being Index (WHO-5) in patients with VERA. Moreover, we examined the statistical relationship of these indexes with various clinical and laboratory RA associated parameters such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF)-/ cyclic citrullinated peptide antibodies (anti-CCP)-status and Disease Activity Score 28 (DAS28) as well as its components [counts of tender and swollen joints, Visual Analogue Scale (VAS)]. Results 74 Patients (50 females, 24 males) with a median age of 62 years (IQR 49, 71) were identified as VERA patients. 36 of them were anti-CCP positive and 34 RF positive. Median scores for HFAQ, HAQ, EQ-5D-3L, FACIT-Fatigue, and WHO-5 were 75.5 (IQR 61, 92.5), 0.75 (IQR 0.26, 1.25), 0.89 (IQR 0.79, 0.89), 40 (IQR 32, 46) and 60 (IQR 32, 76) accordingly. The results of the statistical associations between these scores and RA associated parameters are seen in Table 1. Conclusions The quality of life indexes HFAQ, HAQ, EQ-5D-3L and WHO-5 are associated with two or more markers of disease activity in patients with VERA. Therefore, improvement of patients9 quality of life is linked to the achievement of disease remission. In contrast, the FACIT-fatigue index seems to be solely associated with arthritis pain intensity. Thus, improvement of fatigue requires an effective pain management strategy. References Gossec L et al., RMD Open. 2015 Apr 2;1(1):e000019. Her M et al., Curr Opin Rheumatol, 2012 May;24(3):327–34. Disclosure of Interest None declared