Background/Purpose: in rheumatoid arthritis (RA) patients the disease outcome has an unpredictable course and may differ even with an early diagnosis and treatment. Low disease activity is associated with favourable outcome and a normal level of functionality. It is desirable to identify patients with a high probability of sustained disease activity in an early stage. The purpose is to identify clinical baseline predictor factors associated with sustained disease activity after 12 months of follow up in patients with early RA.

Methods: demographic, clinical, laboratory and treatment data of patients with an established diagnosis of RA (according to physician diagnosis) were recruited from an early arthritis clinic at baseline and after 12 months of follow-up. Sustained disease activity at 12 months was defined as DAS28 >3.2 and SDAI >11. Univariate and multivariate logistic regression of DAS28 and SDAI disease activity were performed at baseline and after 12 months

Results: 566 patients diagnosed of RA were included. 75.8% (429) were women with a predominance of Caucasian (74.7%; 423) an age average of 54 +/- 17 years old at the baseline visit and a mean of 16+/- 15 weeks since symptoms onset. 440 (77.7%) had positive rheumatoid factor and 373 (65.9%) had positive ACPA. 508 (89.8%) patients received Methotrexate as first line treatment and 459 (81.1%) received glucocorticoids. At baseline 88.8% (487) had moderate-high disease activity with DAS28 and 77.6% (439) with SDAI. After one year of follow-up, 34% (170) had moderate-high activity with DAS28 and 30.9% (175) with SDAI. Univariate logistic regression analysis results are shown in Table 1. On multivariate analysis we found that a higher DAS 28 score at baseline visit (OR 1.34; p=0.02) was associated with sustained disease activity after 12 months. Higher tittle of rheumatoid factor (OR 2.6; p=0,019), higher HAQ (OR 1.06; p=0.005) and high doses of glucocorticoids at baseline visit (OR 2.1; p=0.025) were associated with sustained disease activity after 12 months with SDAI score.

Table 1. Univariate logistic regression analysis results (baseline visit)

Conclusion: 34% of RA patients had moderate-high activity with DAS28 and 30.9% with SDAI after 12 months of follow up even with an early diagnosis and intensive treatment. With the DAS28 score, high clinical activity at baseline can predict a sustained disease activity after one year; however with the SDAI score a high rheumatoid factor tittle, an impaired functionality and the need of higher doses of glucocorticoids at baseline can predict a sustained disease activity after one year, showing a poor correlation between both indexes

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-predictor-factors-associated-with-sustained-disease-activity-among-patients-with-early-rheumatoid-arthritis/