Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: To analyze clinical remission in patients with early RA and undifferentiated arthritis (UA) during the first 2 years of treatment using methotrexate (MTX) and prednisone.
Methods: Database included patients diagnosed with early RA, less than 2 years of evolution. Patients were divided into 3 groups according to when the treatment was started 0-3 months, >3-6 months or >6 months of onset of symptoms. Descriptive statistics were applied to each of the variables Student’s t-test and the chi-squared test were applied and Fisher’s exact test was used where necessary. Univariate analysis was performed using Mann Whitney test and Multivariate logistic regression models were used to measure the association with remission defined by DAS 28, SAI, CDAI, and ACR/EULAR scores. A value of p ≤ 0.05 was considered significant.
Results: Of 2078 included patients, 442 were available for the intent-to-treat analysis (ITT). 83% were women with mean age 52.74 years (SD 14.05) and a median duration of symptoms of 6.5 months (IQR 3.0–12.0) by the time they entered into the study. Of the total, 303 (68.6%) had RA (ACR 1987) and 139 (31.4%) UA. ESR 35.15 mm/h (IQR15-48.75), CRP 16.77 mg/dl,(IQR 0.5 to 11.51), positive RF in 275 (62.2%) patients. The clinical characteristics at baseline were: HAQ 1.17 (IQR 0.5-1.75), DAS 28 5.14 (SD 1.32), CDAI 25.98 (IQR 15-35), IAS 28.68 (IQR 18.42-38.57), hands SENS 8.34 (IQR 2-13), feet SENS 2.64 (IQR 0-4). During the study, 415 (93.9%) received MTX (average dose 15mg/week) and prednisone (average dose 7.97 mg/day) in 410 (99.8%) patients. MTX and prednisone were initiated with a mean at 8.83 (IQR 3-13) months and 7.55 (IQR 2-12) months, respectively, from the onset of symptoms. The patients who reached remission at some point in 2 years follow-up measured by DAS 28 were in 305 (69%), by IAS in 288 (65.2%), by CDAI in 255 (57.7%) and by ACR/EULAR score in 224 (50.7%) patients. Table 1 and 2 show higher remission percentages in a group of patients were treated with combination therapy with MTX and prednisone, especially in those who the onset of symptoms was before 6 months of evolution of the disease. In multivariate analysis, patients treated with MTX achieved remission at some point the follow up with DAS28 (OR 3.88, 95%CI 1.66-9.06, p=0.002), IAS (OR 2.98, 95%CI 1.50-5.88, p=0.002), CDAI (OR 3.00, 95%CI 1.57-5.72, p=0.001), ACR/EULAR score (OR 2.80, 95%CI 1.49-5.25, p=0.001) and lower HAQ at baseline in those who had less 3 months from the onset of symptoms. Table 1: Remission percentages in patients who received combined treatment with MTX and prednisone. Univariate analysis.
|Remission||MTX/Prednisone (NO) n (%)||MTX/Prednisone (YES) n (%)||P|
|DAS 28 < 2.6||93 (60.0%)||212 (73.9%)||0.004|
|SAI < 5.5||87 (56.1%)||201 /70.0%)||0.005|
|CDAI < 2.8||81 (52.3%)||174 (60.6%)||0.11|
|ACR/EULAR||65 (41.9%)||159 (55.4%)||0.007|
Table 2. Remission by the different scores depending on the time of treatment start from the onset of symptoms. Univariate analysis.
|Remission||MTX/Prednisone 0-3 months n (%)||MTX/Prednisone >3-6 months n (%)||MTX/Prednisone > 6 months n (%)||P|
|DAS 28 < 2.6||87 (73.7%)||70 (76.8%)||128 (63.7%)||0.04|
|SAI < 5.5||87 (73.7)||67 (70.5%)||121 (60.2%)||0.03|
|CDAI < 2.8||82 (68.9%)||60 (63.2%)||100 (49.8)||0.02|
|ACR/EULAR||74 (62.2%)||56 (58.9%)||85 (42.3%)||0.01|
Conclusion: Early treatment with MTX and prednisone is associated with greater opportunities to reach remission.
To cite this abstract in AMA style:Retamozo S, Haye Salinas MJ, Pirola JP, Baenas D, Alvarez AC, Saurit V, Alvarellos A, Waimann CA, Citera G, Dal Pra F, Orozco C, Ceccato F, Paira S, Martire M, Crespo Amaya G, Secco A, Mamani M, Rosa J, Soriano E, Marcos J, García MA, Costi C, Zalazar MM, Martinez Muñoz A, Rillo OL, Berman H, Berman A, Colombres F, Velozo EJ, Juarez VR, Crespo M, Quinteros A, Leal M, Salvatierra G, Sacnún M, Quintana R, Abdala M, Caeiro F. Benefit of Early Therapy with Methotrexate and Prednisone in Patients with Early Rheumatoid Arthritis and Undifferentiated Early Arthritis (CONAART) [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). http://acrabstracts.org/abstract/benefit-of-early-therapy-with-methotrexate-and-prednisone-in-patients-with-early-rheumatoid-arthritis-and-undifferentiated-early-arthritis-conaart/. Accessed May 25, 2018.
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