ACR Meeting Abstracts

ACR Meeting Abstracts

  • Home
  • Meetings Archive
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP PRSYM
    • 2016-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • Register
    • View and print all favorites
    • Clear all your favorites
  • Meeting Resource Center

Abstract Number: 2984

Lifestyle and MTX Use Are the Strongest Predictors of Not Achieving Remission in the First Year of Rheumatoid Arthritis: Results from the Canadian Early Arthritis Cohort (CATCH)

Susan J. Bartlett1,2, Orit Schieir3, Marie-France Valois4, Carol Hitchon5, Louis Bessette6, Gilles Boire7, Carter Thorne8, Janet E. Pope9, Vivian P. Bykerk10, Edward C. Keystone11, Diane Tin12 and Glen Hazlewood13, 1Department of Medicine, Division of ClinEpi, Rheumatology, Respirology, McGill University, Montreal, QC, Canada, 2Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, 3McGill University, Montreal, ON, Canada, 4McGill University, Montreal, QC, Canada, 5University of Manitoba, Winnipeg, MB, Canada, 6Division of Rheumatology, Department of Medicine, CHU de Québec-Université Laval, Québec, QC, Canada, 7Rheumatology Division, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke and Universite de Sherbrooke, Sherbrooke, QC, Canada, 8University of Toronto, Newmarket, ON, Canada, 9Department of Medicine, University of Western Ontario, London, ON, Canada, 10Hospital for Special Surgery, New York, NY, 11Mount Sinai Hospital, Toronto, ON, Canada, 12The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 13Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Early Rheumatoid Arthritis, methotrexate (MTX), obesity, Outcomes and remission

  • Tweet
  • Email
  • Print
Save to PDF
Session Information

Date: Wednesday, October 24, 2018

Session Title: 6W023 ACR Abstract: RA–DX, Manifestations, & Outcomes VI: Outcomes Reports (2982–2987)

Session Type: ACR Concurrent Abstract Session

Session Time: 11:00AM-12:30PM

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.

Women

Men

N

1179

449

Sociodemographics

Age (each 10 years)

1.04 (0.95, 1.14)

1.48 (1.22, 1.79)

Minority race

1.46 (1.07, 2.00)

Not selected

Education ≤ high school

1.41 (1.09, 1.82)

Not selected

Comorbidities

1.12 (1.05, 1.21)

Not selected

Obese (BMI > 30 kg/m2)

2.06 (1.49, 2.83)

1.65 (0.95, 2.85)

Current smoking

Not selected

3.45 (2.06, 5.77)

RA Characteristics

Symptom duration (month)

1.10 (1.05, 1.14)

1.15 (1.07, 1.24)

Family history of RA

Not selected

1.62 (0.95, 2.77)

RF+ or ACPA+

1.23 (0.87, 1.75)

Not selected

Erosions

Not selected

Not selected

MTX Use

0.72 (0.54, 0.95)

0.55 (0.33, 0.90)

Oral Steroids (Y vs N)

0.80 (0.60, 1.07)

1.45 (0.92, 2.27)

Parenteral Steroids (Y vs N)

Not selected

Not selected

ESR (mm/h)

1.01 (1.01, 1.02)

1.02 (1.01, 1.03)

Swollen Joint Count (28)

Not selected

Not selected

Tender Joint Count (28)

1.03 (1.01, 1.06)

Not selected

Patient Reported Outcomes

High depressive symptoms

Not selected

Not selected

Pain (0-10)

Not selected

1.11 (1.03, 1.20)

HAQ-DI (0-3)

Not selected

Not selected

Fatigue (0-10)

1.05 (1.00, 1.09)

Not selected

Fit Statistics

AIC

1519

535

BIC

1601

581

Area under the curve

0.69

0.74


Disclosure: S. J. Bartlett, UCB, Inc., 5,Lilly, 5,Pfizer, Inc., 5,Novartis, 5; O. Schieir, Other, 2; M. F. Valois, Other, 2; C. Hitchon, Pfizer, Inc., 2; L. Bessette, Amgen Inc., 2, 5, 8,Bristol-Myers Squibb, 2, 5, 8,Janssen, 2, 5, 8,Roche, 2, 5, 8,UCB, Inc., 2, 5, 8,AbbVie Inc., 2, 5, 8,Pfizer, Inc., 2, 5, 8,Merck & Co., 2, 5, 8,Celgene Corporation, 2, 5, 8,Sanofi, 2, 5, 8,Eli Lilly and Co., 2, 5, 8,Novartis, 2, 5, 8; G. Boire, Merck & Co., 8, 9,BMS, 8, 9,Pfizer, Inc., 8, 9,Amgen Inc., 9,AbbVie Inc., 9,Novartis, 9,Eli Lilly and Co., 9,Janssen, 9; C. Thorne, Amgen Inc., 2, 5, 9,Pfizer, Inc., 2, 5, 9,UCB, Inc., 9,AbbVie Inc., 2, 5, 9,Medexus/Medac, 2, 5, 8,Eli Lilly and Co., 9,Merck & Co., 9,Hospira, 5, 9,Janssen, 9,Sanofi Genzyme, 5, 9,Celgene Corporation, 9,CaREBiodam, 9,Centocor, 5,Novartis, 9; J. E. Pope, Amgen Inc., 5, 9,Pfizer, Inc., 5, 9,UCB, Inc., 5, 9,AbbVie Inc., 5,Bristol-Myers Squibb, 5, 9,Actelion, 5,Eli Lilly and Co., 5,Merck & Co., 5, 9,Bayer, 5, 9,Roche, 5, 9,Novartis, 5,Sanofi, 5,Celtrion, 5,Seagen, 9,Genzyme, 5; V. P. Bykerk, Amgen Inc., 5,Pfizer, Inc., 5,UCB, Inc., 5,Bristol-Myers Squibb, 5,Sanofi-Genzyme/Regeneron, 5; E. C. Keystone, Amgen Inc., 2, 5, 8,Bristol-Myers Squibb, 2,F. Hoffmann-La Roche Inc, 2,Janssen, 2,Lilly Pharmaceuticals, 2,Pfizer Pharmaceuticals, 2,Sanofi-Aventis, 2,AstraZeneca, 5,Biotest, 5,Bristol-Myers Squibb, 5,Crescendo Bioscience, 5,F. Hoffmann-La Roche Inc, 5,Genentech Inc, 5,Janssen Inc, 5,Lilly Pharmaceuticals, 5,Merck & Co., 5, 8,Pfizer Pharmaceuticals, 5,UCB, Inc., 5,Bristol-Myers Squibb, 8,F. Hoffmann-La Roche Inc, 8,Janssen Inc, 8,Pfizer Pharmaceuticals, 8,Sanofi Genzyme, 8,UCB, Inc., 8; D. Tin, None; G. Hazlewood, None.

To cite this abstract in AMA style:

Bartlett SJ, Schieir O, Valois MF, Hitchon C, Bessette L, Boire G, Thorne C, Pope JE, Bykerk VP, Keystone EC, Tin D, Hazlewood G. Lifestyle and MTX Use Are the Strongest Predictors of Not Achieving Remission in the First Year of Rheumatoid Arthritis: Results from the Canadian Early Arthritis Cohort (CATCH) [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/lifestyle-and-mtx-use-are-the-strongest-predictors-of-not-achieving-remission-in-the-first-year-of-rheumatoid-arthritis-results-from-the-canadian-early-arthritis-cohort-catch/. Accessed April 13, 2021.
  • Tweet
  • Email
  • Print
Save to PDF

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/lifestyle-and-mtx-use-are-the-strongest-predictors-of-not-achieving-remission-in-the-first-year-of-rheumatoid-arthritis-results-from-the-canadian-early-arthritis-cohort-catch/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

ACR Convergence: Where Rheumatology Meets. All Virtual. November 5-9.

ACR Pediatric Rheumatology Symposium 2020

© COPYRIGHT 2021 AMERICAN COLLEGE OF RHEUMATOLOGY

Wiley

  • Home
  • Meetings Archive
  • Advanced Search
  • Meeting Resource Center
  • Online Journal
  • Privacy Policy
  • Permissions Policies
loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.