Background/Purpose: Achievement of clinical remission in rheumatoid arthritis (RA) is now the goal of therapy to reduce joint damage and disability, and maintain or improve quality of life. Sustained remission is critical to attain these outcomes. Predictive factors for sustained remission of RA are not known. The purpose of this study is to identify prognostic factors of sustained remission and build a predictive model.

Methods: Data from RA patients registered in a nationwide Japanese cohort database (NinJa : National Database of Rheumatic Diseases by iR-net in Japan) in 2009 and 2010 were used to evaluate baseline characteristics, treatment profiles, and the following clinical outcomes: tender joint count (TJC), swollen joint count (SJC), C-reactive protein (CRP), ESR, patient Visual analog scale (VAS), physician VAS, and Modified Health Assessment Questionnaire (MHAQ). All patients with SDAI remission in 2009 were divided based on whether remission was maintained in 2010. A multivariate Cox regression model was constructed for predictive factors and a prognostic prediction model was constructed. Bootstrapping was used for internal model validation.

Results: Out of 4215 patients with RA in the 2009 cohort, 930 patients had SDAI remission, and 623 patients (67.0%) had sustained remission after 1 year. Compared to non-sustained remission group, duration of disease, SJC, CRP, ESR, patient VAS, physician VAS, and MHAQ were significantly lower in the sustained remission group (p<0.05). Mean SDAI score in the sustained remission group was 1.45 ± 0.92 versus 2.08 ± 0.86 in the non-sustained remission group (p<0.05). A prognostic prediction model with a total score of 6 points was constructed as follows: 2 points for MHAQ >1; 1 point each for SJC >1, ESR >20, patient VAS >0.5, and physician VAS >0.5. Area under the receiver operating characteristic (ROC) curve for this model was 68.8% (95% CI: 65.0–73.0%). Bootstrapped validation beta coefficients of predictors were identical to the original cohort data.

Conclusion: We found that duration of disease, SJC, CRP, ESR, patient VAS, physician VAS, and MHAQ are significantly lower in those with sustained remission after 1 year. A prediction model was successfully built and validated using clinically relevant parameters.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/can-sustained-remission-of-rheumatoid-arthritis-be-predicted-an-analysis-from-the-japanese-national-database-of-rheumatic-disease-ninja/