Physician Global Assessment At Three Months Is Strongly Predictive Of Remission At 12 Months In Early Rheumatoid Arthritis. Results From The Canadian Early Arthritis Cohort

Tommy Choy¹, Vivian P. Bykerk², Gilles Boire³, Boulos Haraoui⁴, Carol A. Hitchon⁵, J. Carter Thorne⁶, Edward C. Keystone⁷ and Janet E. Pope⁸, ¹Medicine/Rheumatology, University of Western Ontario, London, ON, Canada, ²Divison of Rheumatology, Hospital for Special Surgery, New York, NY, ³Rheumatology Division, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada, ⁴Rheumatology, Institut de Rhumatologie de Montréal, Montreal, QC, Canada, ⁵Rheumatology, University of Manitoba, Winnipeg, MB, Canada, ⁶Southlake Regional Health Centre, Newmarket, ON, Canada, ⁷Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, ⁸Medicine, Divsion of Rheumatology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Disease Activity, Early Rheumatoid Arthritis, inflammatory arthritis, outcome measures and remission

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects II: Predictors of Disease Course in Rheumatoid Arthritis - Treatment Approaches

Session Type: Abstract Submissions (ACR)

Background/Purpose:

To determine predictors of 1-year remission in early rheumatoid arthritis (ERA) using baseline and 3 months data.

Methods:

The Canadian Early Arthritis Cohort (CATCH) patients were included if baseline, 3 and 12 months data were available. Regression analyses for four different definitions of remission at 12 months were done to determine baseline and 3 months predictors of remission. Four remission definitions were evaluated: (1) Simplified Disease Activity Index (SDAI) score ≤ 3.3; (2) Clinical Disease Activity Index (CDAI) score ≤ 2.8; (3) 28 Joint Disease Activity Score (DAS28) score < 2.6; (4) Boolean based ACR/EULAR clinical trial definition requiring a tender joint count (TJC) ≤ 1, swollen joint count (SJC) ≤ 1, patient global assessment of disease (PTGA) ≤ 1 on a 0–10 cm scale, and C-reactive protein (CRP) ≤ 1 mg/dl using 28/28 TJC/SJC.

Results:

562 had complete data at 12 months; mean age 53.4 years, disease duration 6.2, 73% were female. The factors at baseline associated with all four remission outcomes at 12 months were age, gender, income, education, TJC, patient global assessment (PTGA), HAQ and pain. Baseline ESR was associated with DAS28 remission only. At 3 months, all four remission definitions were associated with: TJC, SJC, physician global assessment (MDGA), PTGA, HAQ, pain, ESR and CRP in univariate analyses. In the regression model, variables associated with SDAI remission were MDGA (OR 0.77, p<0.001), pain (OR 0.85, p=0.004), age (OR 0.98, p=0.006) and HAQ (OR 0.49, p=0.011); CDAI remission was associated with MDGA (OR 0.77, p<0.001), pain (OR 0.85, p=0.003), Age (OR 0.98, p=0.015) and CRP (OR 0.80, p=0.031). DAS28 remission was predicted by ESR (OR 0.95, p<0.001), MDGA (OR 0.76, p<0.001), age (OR 0.98, p=0.001), HAQ (OR 0.57, p=0.006) and male (OR 2.01, p=0.005), whereas Boolean remission was associated with pain (OR 0.79, p=0.009), age (OR 0.98, p=0.016), PTGA (OR 0.83, p=0.025), and MDGA (OR 0.86, p=0.038).

Conclusion:

Younger age was associated with more remission. A low MDGA at 3 months was consistently associated with 1-year remission in ERA.

Disclosure:

T. Choy,
None;

V. P. Bykerk,

Amgen,

Pfizer Inc,

BMS,

Gennentech,

UCB,

G. Boire,
None;

B. Haraoui,

Amgen, Abbott, Bristol-Myers Squibb, Pfizer, Roche, UCB,

C. A. Hitchon,
None;

J. C. Thorne,
None;

E. C. Keystone,
None;

J. E. Pope,
None.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/physician-global-assessment-at-three-months-is-strongly-predictive-of-remission-at-12-months-in-early-rheumatoid-arthritis-results-from-the-canadian-early-arthritis-cohort/