Background/Purpose: Clinical remission has now become the treatment goal in rheumatoid arthritis (RA), but it is not common in clinical practice. This study aimed to evaluate predictors for achieving remission and it’s sustaining in RA patients.

Methods: A total of 709 RA patients with moderate or high disease activity at enrollment and who have data of two years annual follow-up were included in this analysis from the KORean Observational study Network for Arthritis (KORONA). Clinical remission of RA was defined as a DAS28 score less than 2.6. The prevalence of clinical remission at first follow-up visit was estimated and its predictors were identified using multivariate logistic regression analysis. Using the second follow-up data, we further divided patients who had achieved remission into two groups: sustained remission or not. We also performed multivariate logistic regression analysis to identify predictors for sustained remission. 

Results: Among the patients in moderate or high disease activity (n=709), only 102 patients (14.4%) achieved remission at their first follow-up visit. Patients with remission had lower functional disability (HAQ score 0.68±0.56 vs. 0.91±0.67, P<0.01) and lower disease activity (DAS28 4.13±0.73 vs. 4.59±0.95, P<0.01) at baseline than patients who could not achieve remission. In multivariate analysis, early RA (disease duration of less than 2 years, OR 2.03, 95%CI 1.14-3.59) and moderate disease activity compared to high disease activity at baseline (OR 2.37, 95%CI 1.25-4.50) were identified as predictors for remission (See table).

 Among the patients who are in remission at first visit (n=102), 45 patients (42.1%) stayed in remission while the other 57 patients (57.9%) experienced flare of their disease activity at their second follow-up. Early RA (disease duration <2 years) and moderate disease activity compared to high disease activity at baseline showed increased OR for sustained remission in multivariate logistic model, but there was no statistical significance (OR 2.61, 95%CI 0.84-8.08, OR 3.96, 95%CI 0.82-19.08, respectively).

Conclusion: Short disease duration less than 2 years and lower disease activity are the predictors for achieving remission in RA patients with moderate to high disease activity. These factors might be associated with sustained remission.

Table. Predictors for achieving remission and sustained remission in RA patients with moderate to high disease activity

Baseline characteristic	Predictors for achieving remission		Predictors for sustained remission
	univariate	multivariate	univariate	multivariate
Age (years)
<40	Ref	Ref	Ref	Ref
40-49	0.62 (0.28-1.35)	0.67 (0.30-1.48)	0.96 (0.23-4.10)	1.05 (0.20-5.63)
50-59	0.85 (0.44-1.67)	1.04 (0.51-2.10)	0.58 (0.17-1.99)	0.45 (0.11-1.95)
≥60	0.70 (0.35-1.39)	0.88 (0.41-1.90)	0.38 (0.10-1.35)	0.29 (0.06-1.50)
Female	0.66 (0.36-1.21)	0.82 (0.42-1.58)	0.47 (0.15-1.44)	0.46 (0.11-1.86)
Income level
~$9,999	Ref	Ref	Ref	Ref
$10,000~29,999	0.93 (0.55-1.56)	0.87 (0.49-1.53)	2.29 (0.84-6.23)	3.78 (0.97-14.77)
$30,000~	1.30 (0.78-2.17)	1.16 (0.64-2.12)	1.45 (0.55-3.87)	1.29 (0.33-5.05)
Disease duration
<2 years	1.92 (1.12-3.30)	2.03 (1.14-3.59)	2.40 (0.89-6.48)	2.61 (0.84-8.08)
2≤ and <5 years	1.43 (0.83-2.45)	1.27 (0.73-2.21)	1.84 (0.67-5.03)	2.20 (0.70-6.86)
≥5 years	Ref	Ref	Ref	Ref
HAQ ≥1	1.90 (1.21-2.98)	1.48 (0.90-2.46)	0.65 (0.28-1.51)	0.34 (0.11-1.02)
DAS 28
moderate	2.77 (1.51-5.09)	2.37 (1.25-4.50)	1.31 (0.40-4.31)	3.96 (0.82-19.08)
high	Ref	Ref	Ref	Ref
Biologics use	1.41 (0.71-2.81)	1.72 (0.80-3.67)	0.44 (0.11-1.76)	0.27 (0.05-1.38)
Methotrexate use	1.22 (0.66-2.28)	1.26 (0.65-2.42)	–	–
Steroid use	1.03 (0.61-1.73)	1.08 (0.62-1.86)	–	–

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/what-factors-lead-to-achieve-and-sustain-remission-in-rheumatoid-arthritis-patients-with-moderate-to-high-disease-activity/