Session Information
Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality
Session Type: Abstract Submissions (ACR)
Background/Purpose : Early and sustained remission has become the ultimate goal in early arthritis patients. The aim of our study was to estimate the prevalence of clinical, sustained and drug free remission in patients with early arthritis, and to explore possible predictive factors of remission.
Methods: We included a cohort of DMARDs naïve patients with diagnosis of early rheumatoid arthritis (RA) or undifferentiated arthritis (UA) of less than 2 years of disease duration. Data was collected every 3 months, including sociodemographic characteristics, functional status, disease activity and medication. Remission was defined according to 2010 ACR/EULAR criteria. We selected four outcomes: Clinical Remission, Drug-Free Remission, steroids-Free Remission (Patients receiving DMARDs but not corticosteroids) and Sustained remission (patients who in the last follow up visit were still in remission). Time to outcome was assessed from date of baseline visit to the date of remission or last follow-up. Kaplan-Meier product limit method was used to estimate probability of each outcome. Patients were stratified according to initial and final diagnosis: UA-UA, UA-RA and RA-RA, respectively. Groups were compared with the log-rank statistic. Cox proportional hazards (PH) models were fit to determine possible predictors of remission including gender, age, disease duration, HAQ, DAS28, rheumatoid factor and baseline diagnosis.
Results: A total of 684 patients were included: UA-UA=125 (18%), UA-RA= 127 (19%) and RA-RA= 432 (63%). Mean follow-up was 21 ± 16 months (1228 patients-year). Baseline DAS28 and HAQ were 5.2 ± 1.3 and 1.2 ± 0.8, respectively. Mean age was 51 ± 15 years, 81% were female and 62% had positive rheumatoid factor. The mean disease duration was 7 ± 6 months. At baseline, 625 (98%) of patients were not in remission. During follow-up 36% achieved clinical remission at a median time of 12 months. Only 54% of these patients continued in sustained remission (median follow-up after first remission= 17 months). Steroids-free remission and Drug-free remission were achieved in 21% and 13%, respectively. The overall probability of remission per patients-year of follow-up were 0.29, 0.13, 0.07; for clinical, steroids-free and drug-free, respectively. There were no differences in rate of remission between different diagnosis groups. On multivariate analysis, male gender and baseline diagnosis of RA were associated with higher probability of remission (HR=1.70, p=0.001 and HR=1.43, p=0.03, respectively), while higher HAQ-score and longer disease duration were associated with lower probability of remission (HR=0.77, p=0.01 and HR=0.95, p=0.001; respectively).
Conclusion: In our cohort 36% of patients with early arthritis achieved clinical remission; however half of them relapse during follow-up. Only one in every ten patients reached drug free remission. A short disease duration, lower disability, male gender and initial diagnosis of RA were associated with higher probability of remission.
Disclosure:
M. Landi,
None;
C. A. Waimann,
None;
G. Citera,
None;
O. Cerda,
None;
F. Ceccatto,
None;
S. Paira,
None;
F. Caeiro,
None;
L. Marino,
None;
M. Mamani,
None;
A. Secco,
None;
G. Crespo,
None;
A. Alvarez,
None;
M. Haye Salinas,
None;
A. Alvarellos,
None;
J. Rosa,
None;
V. Scaglioni,
None;
E. R. Soriano,
None;
J. Marcos,
None;
M. García,
None;
A. Salas,
None;
A. Martinez,
None;
R. Chaparro del Moral,
None;
O. L. Rillo,
None;
H. Berman,
None;
A. Berman,
None;
F. Colombres,
None;
E. Veloso,
None;
R. V. Juárez,
None;
M. E. Crespo,
None;
A. Quinteros,
None;
M. Leal,
None;
G. Salvatierra,
None;
C. Ledesma,
None;
M. P. Sacnun,
None;
R. Quintana,
None;
M. Abdala,
None.
« Back to 2014 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-and-predictive-factors-of-drug-free-and-sustained-remission-in-patients-with-early-arthritis/