Background/Purpose:

The relevant elements to evaluate health states in RA should include remission, good functional ability and structural stability [1]. The concept of favorable outcome could then be defined by the association of these 3 elements. An alternative definition of favorable outcome keeps only the last 2 criteria: function + structure.

Objective: To assess which variables at baseline are associated with sustained favorable outcome over 3 years in early arthritis (EA) in daily clinical practice

Methods: – Patients: from the French cohort of EA ESPOIR (at least 2 swollen joints for less than 6 months and suspicion of RA) fulfilling the new ACR-EULAR criteria for RA at baseline.

               – Outcome: favorable outcome was defined by a criterion representing good functional ability (HAQ ≤0.5 and HAQ deterioration ≤0.25) and a criterion representing structural damage (absence of progression of the Sharp score over 1 year) with or without remission according to the new criteria of ACR / EULAR. Patients with sustained favorable outcome (according to the two definitions, ie using 2 and 3 criteria) over 3 years were analyzed.

                – Analysis: multinomial and ordinal logistic regression were used to determine which variables at baseline were independently associated with sustained favorable outcome. Sensitivity analyses on different definition of ‘sustained’ favorable outcome (sum, continuity rewarded score [2]) and on the timing of the treatment’s introduction were performed.

Results:

643 patients were analyzed (mean age of patients 48±12 years; 78% were women; mean DAS28 5.4±1.2). In all, 97 patients presented sustained favorable outcome using 2 criteria (function+structure) at least at 2 time-points and 29, sustained favorable outcome using 3 criteria. (function+structure+remission).  In the logistic regression models, only low HAQ and morning stiffness were always associated with sustained favorable outcome whatever the definition used (3 or 2 criteria). Being younger, living with a partner (being married/in a common-law relationship) and biological treatment during the first 6 months were associated with sustained favorable outcome using the 3 criteria (including remission). Being male, low Sharp score and no synthetic DMARD during the first year were associated with sustained favorable outcome using the 2 criteria (function+structure) (Table). To note the introduction of biological treatment after 6 months was not associated with sustained favorable outcome.

Variable at  J0	OR [95%CI] Sustained favorable outcome structure+function+remission	OR [95%CI] Sustained favorable outcome structure+function
Low age	1.17 [1.07;1.28]	NS
Low TJC	1.24 [1.01;1.54]	NS
Living with a partner	16.67 [1.04;250]	NS
Biological treatment during the first 6 months	28.6 [1.92;500]	NS
Low HAQ	31.25 [3.08;333.3]	2.38 [1.45;3.93]
Morning stiffness >1h	6.80 [1.46;31.2]	3.09 [1.99;4.78]
Low Sharp score	NS	1.03 [1.005;1.06]
Male	NS	1.70 [1.05;2.77]
No synthetic DMARD during the first year	NS	1.70 [1.06;2.72]

Conclusion: Early initiation of biological treatment is an important predictor of sustained favorable outcome (function+structure+remission) but not of sustained favorable outcome on structure and function only.

1.Felson DT et al. Ann Rheum Dis 2011; 70(3):404-13

2.Boers M, et al. J Clin Epidemiol. 2010 Jun;63:633-7

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/early-introduction-of-biologic-treatment-is-an-important-predictor-of-sustained-favorable-outcome-including-clinical-remission-in-early-arthritis-but-not-of-sustained-favorable-outcome-on-structure-an/