Background/Purpose: Implementation of RA guidelines have improved remission outcomes in RA; nevertheless 45% of early RA participants do not achieve remission in the first year. Moreover, fewer women reached remission than men. Our goal was to identify and compare predictors of persistent disease activity (LDA/MDA/HAD) in the first year of RA treatment in men and women.

Methods: Sample included adults in CATCH (Canadian Early Arthritis Cohort) from 2007-16 with active disease at baseline and ≥12m F/U. Standardized visits included clinical assessments, questionnaires, and lab tests. Logistic regression with backward selection was used to identify predictors of failing to achieve remission (DAS28<2.6) by 12 months among baseline sociodemographic and RA characteristics and patient reported outcomes.

Results: The sample included 1628 adults with 2010 or 187 ACR/EUAR criteria for RA, who were mostly female (72%) with a mean (SD) age of 55 (15), with 2 (2) comorbidities, and symptom duration of 6 (3) months. At enrollment, all had active disease (DAS28 MDA (42%); HDA (53%)), almost all most were initially treated with csDMARDS and 75% with MTX. 44% of women and 36% of men did not reach remission by 12 months. Among women, multivariable results showed obesity more than doubled the likelihood of not achieving remission; other key predictors were minority status, lower education, and higher TJC and fatigue scores at baseline (Table). In men, current smoking was associated with a 3.5 greater odds of not achieving remission in the first year; other predictors included older age, and higher pain. Not using MTX increased the likelihood of not achieving remission in women by 28% and men by 45%. Longer symptom duration and higher ESR were associated with not achieving remission in all. Factors not related to persistent disease activity included family history of RA, RF/ACPA status, erosions, SJC, HAQ and depressive symptoms at baseline.

Conclusion: In this large pan-Canadian cohort of early RA patients receiving guideline-based arthritis care, obesity in women and current smoking in men were the strongest predictors of not achieving remission in the first 12 months followed by non-use of MTX, higher baseline inflammation and longer symptom duration. Additional poor prognostic indicators in women included minority status, lower education, and higher fatigue, whereas older age and greater pain were associated with persistent disease activity in men. Smoking cessation in men and weight reduction in women, and optimizing MTX use may facilitate rapid reduction of inflammation, an essential goal of treatment in early RA.