Background/Purpose: Uncontrolled Rheumatoid Arthritis (RA) leads to disability, damage, and poor health-related quality of life (HRQoL). Current treatment recommendations emphasize the importance of achieving remission or Low Disease Activity (LDA) ⁽¹⁾ to avoid the aforementioned results.  In Latin American, RA patients have been shown to achieve low remission but high disability rates. ^(2-4) and the alternative LDA, could be a reasonable treatment goal.  Objective: To explore the impact of not achieving remission over time on the HRQoL in RA patients.

Methods: RA patients from a longitudinal established RA cohort (ACR1987/ACR-EULAR2010 criteria) from a single center were studied. This cohort was established to describe the clinical outcomes of RA Peruvian patients; for this analysis, subjects with at least two evaluations (half-yearly) were included. In each visit clinical remission state was defined if they achieved a 3.3 value in the Simple Disease Activity Index (SDAI). Also, non-remission categories were defining in according to SDAI definition ( >3.3 to ≤11.0; >11.0 to ≤26 and > 26 to low, moderate and high activity disease, respectively). HRQoL was explored with the Short Form 36 Health Survey Questionnaire (SF-36). A generalized estimating equation model was used to explore each SDAI category as a predictor of the summary measures, mental (MCS), and physical (PCS) of the SF-36 obtained on the subsequent visit. The multivariable models were adjusted for other predictors: gender, age at diagnosis, education, socio-economic level (measured by the Graffar scale), disease duration, tobacco use, anti-citrullinated protein antibodies level, disability (MDHAQ), use of conventional (c), and biologic (b) DMARDs, use of corticosteroids (current use, past use or non-use) and the baseline score of the corresponding SF-36 summary measure.

Results: Four hundred thirteen patients were included, 375 (90.8%) were women; age at diagnosis was 43.9 (13.5) years, disease duration was 16.7 (11.4) years. At the baseline visit, the SDAI was 25.6 (22.8); only 4.1% patients were in remission; 14.3%, 41.9% and 39.7 were in low, moderate and high  disease activity, respectively; MDHAQ was 0.7 (0.5); current corticosteroid use was 31.6%, cDMARD 59.2% and only 7.8% were in bDMARD treatment. The PCS was 40.5(18.4) and the MCS 45.7 (16.6). One thousand and nineteen visits were analyzed in the follow-up (2.71 per patient). In the multivariable analysis, not achieving remission state was associated with a worse HRQoL; these data are depicted in table 1.

Conclusion: Not achieving remission states predicted a worse HRQoL in the follow-up of RA patients, in our real world cohort. These results reinforced the importance of remission as a goal of RA management in clinical practice in our region.
(1). Smolen. Ann Rheum Dis. 2016;75:3-15. (2) Gamboa. Clin Rheum 2019 doi 10.1007/s10067-019-04618-x  (3) Cardiel J Clin Rheumatol. 2012; 18:327-35. (4) Massardo Arthritis Care Res 2012; 64:1135-1143

Table 1-RA

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/not-achieving-clinical-remission-predicts-a-poor-health-related-quality-of-life-in-rheumatoid-arthritis-patients-results-of-a-latin-american-real-world-database/