Background/Purpose: Despite the conspicuous increase in available treatment for rheumatoid arthritis [RA], and the shift to early, more aggressive management, there is a paucity of reliable prognostic markers to assist in the stratification of therapy in individual patients.  As a result, individualized risk-adapted therapy for patients with RA remains a desirable, but elusive goal. The primary objective of this study was to assess the association between baseline clinical prognostic factors and subsequent DAS remission in early RA patients.

Methods: The study utilised point of care clinical software to collect data from 20 participating rheumatology treatment centres. Newly diagnosed RA patients over the age of 18 years treated at a participating clinic were eligible.  Patients were required to have attended the clinic on at least two occasions in 6 months and have at least two available DAS assessments. Clinical predictors of outcome were identified and the list was refined by consensus.  Data captured included baseline demographics, mode of disease onset, pattern of joint involvement at onset, smoking status, DAS, RF and CCP titre, time from onset of symptoms to presentation and disease activity at baseline. Statistical analysis utilized a univariate and multivariate logistic regression of DAS28ESR remission 12 months after the first assessment.

Results:

1,121 patients were included in the analysis (71% female, 29% male).  434 patients were RF positive, 265 CCP positive. Mean age 61.3 years (SD 13.4).

The strongest baseline predictors of DAS28ESR remission at 12 months were younger age, male and low disease activity at baseline. There was no statistically significant association between joint onset patterns, mode of onset, RF or CCP status and smoking status.

The association between DAS28ESR remission at 12 months and age was borderline significant. Odds ratio for age was 0.985 (95% CI = (0.969, 1.01)). For each additional decade of age, the odds of being in remission at 12 months decreased by 15% (p = 0.057)

For female patients the odds of being in remission at 12 months was 0.887;for male patients the odds of being in remission at 12 months was 2.00; therefore the odds of a male patient being in remission at 12 months was 2.256 times greater than those for female patients (OR 2.256, 95% CI = (1.384, 3.675), P<0.001.)).

For patients who were in remission at baseline the odds of being in remission at 12 months was 2.44; for patients who were not in remission at baseline the odds of being in remission at 12 months was 0.57; therefore the odds of a patient in remission at baseline being in remission at 12 months were 4.28 time greater than those patients not in remission at baseline (OR 4.28, 95% CI = (2.56, 7.17), P < 0.001.)).

Conclusion: The strongest baseline predictors of DAS remission at 12 months were younger age, low baseline disease activity and male gender. Traditional prognostic factors associated with outcome such as smoking and CCP status were not strong predictors of outcome at 12 months. The study identifies potential high-risk groups that may benefit from more frequent clinical assessment and therapy adjustment. The cohort will be followed over the next five years to provide data on long term outcome.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-longitudinal-study-of-prognostic-factors-in-patients-with-early-ra-providing-direction-for-future-clinical-treatment-predict-study/