ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 503

Predictors for Attaining Remission at Two Consecutive Visits in Newly Diagnosed Early RA Patients

T. Martijn Kuijper1, J.J. Luime2, P.H.P. de Jong3, A. H. Gerards4, Derkjen van Zeben5, I. Tchetverikov6, P.B.J. de Sonnaville7, M. van Krugten8, B. Grillet9, Mieke Hazes10 and A.E.A.M. Weel11,12, 1Rheumatology, Erasmus MC, Rotterdam, Netherlands, 2Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands, 3Department of Rheumatology, Erasmus Medical Center, Rotterdam, Netherlands, 4Rheumatology, Vlietland Hospital, Schiedam, Netherlands, 5Rheumatology, Sint Franciscus Gasthuis, Rotterdam, Netherlands, 6Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands, 7Oosterschelde Hospital, Goes, Netherlands, 8Rheumatology, Admiraal de Ruyter Hospital, Vlissingen, Netherlands, 9Rheumatology, ZorgSaam Hospital, Terneuzen, Netherlands, 10Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, 11Rheumatology, Erasmus University Medical Center, Rotterdam, Netherlands, 12Department of Rheumatology, Maasstad Hospital, Rotterdam, Netherlands

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: ,

Session Information

Date: Sunday, November 8, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Early and intensive treatment with DMARDs are essential for
remission induction in newly diagnosed RA patients. However, demographic,
psychosocial and disease related factors may play a role as well.

Objectives:

To investigate which demographic, psychosocial and disease
related factors are associated with attaining remission at two consecutive
visits in early RA patients treated in a treat-to-target manner

Methods:

We used 2 years follow-up data
from patients participating in the tREACH trial1,2 in which
induction therapy strategies were compared: (A) combination high dose
conventional therapy ((MTX + sulfasalazine + hydroxychloroquine or (B) MTX.
Both groups had glucocorticoid (GCs) bridging. Disease activity (DAS) was
assessed every 3 months. Remission was defined as DAS<1.6 at 2 consecutive visits
(3 months). Univariate and multivariate logistic regression analyses were
performed including demographic, disease related and psychosocial factors
evaluated at baseline as predictors for attaining remission during 24 months of
follow-up.

Results:

281 patients (68% female; mean DAS 3.4, median HAQ 1.00) were
included. During 2 years of follow-up, 139 of 281 (49%) patients (group A: 93
(51%), group B: 46 (47%)) attained remission at 2 consecutive visits.
Univariate analysis revealed that older age and female sex were associated with
a lower chance of attaining remission (demographic factors). Similar relations
were observed for higher DAS, HAQ and worse physical functioning (disease
factors) and higher levels of anxiety, depression, fatigue and passive coping
with pain (psychosocial factors). In multivariate analysis within blocks of
covariates, age and sex maintained significance in the block of demographic
factors, DAS and ACPA positivity in the block of disease factors and fatigue in
the block of psychosocial factors. In the final model combining the independent
block predictors, age, sex and fatigue remained significant.

Conclusion:

In the tREACH trial, 50% of early RA patients attained remission
within 2 years of follow-up.  Older age, female sex, higher baseline DAS, ACPA
positivity and fatigue were important predictors for not attaining remission,
but in the final model only age, sex and fatigue remained. Results suggest that
high levels of fatigue may prevent patients from attaining remission despite treatment
according to a tight control and treat-to-target strategy.

References

1. Claessen et al. BMC Musculoskelet
Disord 2009:71.

2. De Jong et al. Ann Rheum Dis. 2013 Jan;72

Table 1 Predictors for attaining remission

 

Univariate

Multivariate,

within block of covariates*

Multivariate,

all**

 

OR

p

OR

P

OR

P

Demographics

 

 

 

 

 

 

Age

0.983

0.047

0.979

0.033

0.976

0.036

Sex (female)

0.343

<0.001

0.279

<0.001

0.326

0.001

Dutch ethnicity

1.229

0.549

 

 

 

 

Paid work

0.789

0.079

 

 

 

 

 

 

 

 

 

 

 

Disease

 

 

 

 

 

 

MTX monotherapy

0.883

0.619

 

 

 

 

DAS (baseline)

0.662

0.002

0.651

0.002

 

 

HAQ (baseline)

0.578

0.005

 

 

 

 

SvH (baseline)

0.964

0.305

 

 

 

 

RF positive

1.230

0.499

 

 

 

 

ACPA positive

0.589

0.083

0.498

0.035

 

 

Duration of complaints

1.000

0.716

 

 

 

 

Physical functioning (SF36 PCS)

1.047

0.021

 

 

 

 

 

 

 

 

 

 

 

Psychosocial

 

 

 

 

 

 

Mental functioning (SF36 MCS)

1.026

0.173

 

 

 

 

Internal locus of control (MHLC)

1.062

0.066

 

 

 

 

External locus of control (MHLC)

0.982

0.488

 

 

 

 

Chance locus of control (MHLC)

1.010

0.698

 

 

 

 

Anxiety (HADS)

0.929

0.035

 

 

 

 

Depression (HADS)

0.893

0.004

 

 

 

 

Fatigue (VAS)

0.940

0.008

0.936

0.006

0.947

0.024

Coping with pain (CORS)

0.951

0.048

 

 

 

 

*   After backward selection, variables with p<0.20 in univariate analysis were entered

** After backward selection, variables with p<0.05 in multivariate within block of covariates were entered

Abbreviations:

ACPA      Anti-Citrullinated Protein Antibody

CORS      Coping with Rheumatic Stressors

DAS         Disease Activity Score

HADS      Hospital Anxiety and Depression Scale

HAQ        Health Assessment Questionnaire

MCS        Mental Component Scale

MHLC     Multidimensional Health Locus of Control

MTX        Methotrexate

PCS         Physical Component Scale

RF            Rheumatoid Factor

SF36       Short-Form 36

SvH         Sharp-van der Heijde Score

VAS         Visual Analogue Scale

 

Disclosure: T. M. Kuijper, None; J. J. Luime, None; P. H. P. de Jong, None; A. H. Gerards, None; D. van Zeben, None; I. Tchetverikov, None; P. B. J. de Sonnaville, None; M. van Krugten, None; B. Grillet, None; M. Hazes, None; A. E. A. M. Weel, None.

To cite this abstract in AMA style:

Kuijper TM, Luime JJ, de Jong PHP, Gerards AH, van Zeben D, Tchetverikov I, de Sonnaville PBJ, van Krugten M, Grillet B, Hazes M, Weel AEAM. Predictors for Attaining Remission at Two Consecutive Visits in Newly Diagnosed Early RA Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/predictors-for-attaining-remission-at-two-consecutive-visits-in-newly-diagnosed-early-ra-patients/. Accessed .

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