Predictors and the optimal duration of sustained remission in rheumatoid arthritis
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To determine predictors and optimal duration of sustained remission (SR) in patients with rheumatoid arthritis (RA).
A total of 428 consecutive patients with RA visiting our clinic routinely between 2012 and 2013 were evaluated. Seventy seven of these patients in DAS28 remission were enrolled and followed up for 62.2 ± 9.9 months. Patients in remission ≥ 6 months (SR) and shorter (non: N-SR) were compared in terms of demographic-clinical data and the psychosocial factors. At enrollment, 1st and 5th years, patients in DAS28, SDAI, and Boolean remission were determined.
Sixty three patients were in SR and 14 in N-SR. Lower baseline DAS28 and HAQ scores, anti-CCP were positive predictors of SR. Although the presence of anxiety, depression, fibromyalgia, and fatigue were lower in the SR group, there was no significance. Patients in DAS28 remission (100%) at baseline reduced to 64% at 1st and 42.6% at 5th years. Patients satisfying SDAI and Boolean remission at these three visits were 49%, 44%, and 32.4% vs 41%, 28%, and 20.6%, respectively. If the duration of remission is defined as 6 months, the remission rates of SDAI at inclusion and fifth years’ visits were similar but Boolean remission rates differed significantly and if it is accepted as ≥ 12 months, both the SDAI and Boolean remission rates were not different.
Low DAS28 and HAQ scores at baseline, anti-CCP were positive predictors of SR. Instead of 6 months, remission duration for ≥ 12 months would probably help us to predict SR independently from the chosen criteria; Boolean or SDAI.
KeywordsACR/EULAR definition of remission Disease activity score Predictors Rheumatoid arthritis SDAI Sustained remission
Compliance with ethical standards
Written informed consent was obtained from all patients and the study was approved by the Marmara University School of Medicine Ethics Committee for Clinical and Laboratory Research (the approval number was 09.2012.0208).
- 2.Pollard L, Choy EH, Scott DL (2005) The consequences of rheumatoid arthritis: quality of life measures in the individual patient. Clin Exp Rheumatol 23:43–52Google Scholar
- 3.Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, Kvien TK, Navarro-Compán MV, Oliver S, Schoels M, Scholte-Voshaar M, Stamm T, Stoffer M, Takeuchi T, Aletaha D, Andreu JL, Aringer M, Bergman M, Betteridge N, Bijlsma H, Burkhardt H, Cardiel M, Combe B, Durez P, Fonseca JE, Gibofsky A, Gomez-Reino JJ, Graninger W, Hannonen P, Haraoui B, Kouloumas M, Landewe R, Martin-Mola E, Nash P, Ostergaard M, Östör A, Richards P, Sokka-Isler T, Thorne C, Tzioufas AG, van Vollenhoven R, de Wit M, van der Heijde D (2016) Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 75:3–15CrossRefGoogle Scholar
- 4.Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, Nam J, Ramiro S, Voshaar M, van Vollenhoven R, Aletaha D, Aringer M, Boers M, Buckley CD, Buttgereit F, Bykerk V, Cardiel M, Combe B, Cutolo M, van Eijk-Hustings Y, Emery P, Finckh A, Gabay C, Gomez-Reino J, Gossec L, Gottenberg JE, Hazes JMW, Huizinga T, Jani M, Karateev D, Kouloumas M, Kvien T, Li Z, Mariette X, McInnes I, Mysler E, Nash P, Pavelka K, Poór G, Richez C, van Riel P, Rubbert-Roth A, Saag K, da Silva J, Stamm T, Takeuchi T, Westhovens R, de Wit M, van der Heijde D (2017) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 76:960–977CrossRefPubMedGoogle Scholar
- 6.Einarsson JT, Geborek P, Saxne T, Kristensen LE, Kapetanovic MC (2016) Sustained remission improves physical function in patients with established rheumatoid arthritis, and should be a treatment goal: a prospective observational cohort study from southern Sweden. J Rheumatol 43:1017–1023CrossRefPubMedGoogle Scholar
- 8.Batko B, Urbański K, Świerkot J, Wiland P, Raciborski F, Jędrzejewski M, Koziej M, Cześnikiewicz-Guzik M, Guzik TJ, Stajszczyk M (2019) Comorbidity burden and clinical characteristics of patients with difficult-to-control rheumatoid arthritis. Clin Rheumatol. https://doi.org/10.1007/s10067-019-04579-1
- 9.Iannone F, Salaffi F, Fornaro M, di Carlo M, Gentileschi S, Cantarini L, Lopalco G (2018) Influence of baseline modified rheumatic disease comorbidity index (mRDCI) on drug survival and effectiveness of biological treatment in patients affected with rheumatoid arthritis, spondyloarthritis and psoriatic arthritis in real-world settings. Eur J Clin Investig 48(11):e13013. https://doi.org/10.1111/eci.13013 CrossRefGoogle Scholar
- 10.Khan NA, Spencer HJ, Abda E, Aggarwal A, Alten R, Ancuta C, Andersone D, Bergman M, Craig-Muller J, Detert J, Georgescu L, Gossec L, Hamoud H, Jacobs JWG, Laurindo IMM, Majdan M, Naranjo A, Pandya S, Pohl C, Schett G, Selim ZI, Toloza S, Yamanaka H, Sokka T (2012) Determinants of discordance in patients’ and physicians’ rating of rheumatoid arthritis disease activity. Arthritis Care Res 64:206–214CrossRefGoogle Scholar
- 14.Radner H, Yoshida K, Tedeschi S, Studenic P, Frits M, Iannaccone C, Shadick NA, Weinblatt M, Aletaha D, Smolen JS, Solomon DH (2017) Different rating of global rheumatoid arthritis disease activity in rheumatoid arthritis patients with multiple morbidities. Arthritis Rheum 69:720–727CrossRefGoogle Scholar
- 15.Ajeganova S, van Steenbergen HW, van Nies JA, Burgers LE, Huizinga TW, van der Helm-van Mil AH (2016) Disease-modifying antirheumatic drug-free sustained remission in rheumatoid arthritis: an increasingly achievable outcome with subsidence of disease symptoms. Ann Rheum Dis 75:867–873CrossRefPubMedGoogle Scholar
- 20.Hamann PDH, Pauling JD, McHugh N, Shaddick G, Hyrich K; BSRBR-RA Contributors Group (2019) Predictors, demographics and frequency of sustained remission and low disease activity in anti-tumour necrosis factor-treated rheumatoid arthritis patients. Rheumatology (Oxford) pii: kez188. https://doi.org/10.1093/rheumatology/kez188
- 21.Valor L, Garrido J, Martínez-Estupiñán L, Hernández-Flórez D, Janta I, López-Longo FJ, Monteagudo I, González CM, Naredo E (2018) Identifying markers of sustained remission in rheumatoid arthritis patients on long-term tapered biological disease-modifying antirheumatic drugs. Rheumatol Int 38:1465–1470CrossRefPubMedGoogle Scholar
- 22.Arnett FC, Edworthy SM, Bloch DA, Mcshane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, Medsger TA, Mitchell DM, Neustadt DH, Pinals RS, Schaller JG, Sharp JT, Wilder RL, Hunder GG (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324CrossRefPubMedGoogle Scholar
- 27.Prevoo ML, van 't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48CrossRefGoogle Scholar
- 30.Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LHD, Funovits J, Aletaha D, Allaart CF, Bathon J, Bombardieri S, Brooks P, Brown A, Matucci-Cerinic M, Choi H, Combe B, de Wit M, Dougados M, Emery P, Furst D, Gomez-Reino J, Hawker G, Keystone E, Khanna D, Kirwan J, Kvien TK, Landewe R, Listing J, Michaud K, Martin-Mola E, Montie P, Pincus T, Richards P, Siegel JN, Simon LS, Sokka T, Strand V, Tugwell P, Tyndall A, van der Heijde D, Verstappen S, White B, Wolfe F, Zink A, Boers M (2011) American College of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann Rheum Dis 70:404–413CrossRefPubMedGoogle Scholar
- 34.Castrejón I, Dougados M, Combe B, Fautrel B, Guillemin F, Pincus T (2016) Prediction of remission in a French early arthritis cohort by RAPID3 and other core data set measures, but not by the absence of rheumatoid factor, anticitrullinated protein antibodies, or radiographic erosions. J Rheumatol 43:1285–1291CrossRefPubMedGoogle Scholar
- 36.Haschka J, Englbrecht M, Hueber AJ, Manger B, Kleyer A, Reiser M, Finzel S, Tony HP, Kleinert S, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Wendler J, Schuch F, Ronneberger M, Lorenz HM, Nuesslein H, Alten R, Demary W, Henes J, Schett G, Rech J (2016) Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study. Ann Rheum Dis 75:45–51CrossRefPubMedGoogle Scholar
- 40.Kekow J, Moots RJ, Emery P, Durez P, Koenig A, Singh A, Pedersen R, Robertson D, Freundlich B, Sato R (2010) Patient-reported outcomes improve with etanercept plus methotrexate in active early rheumatoid arthritis and the improvement is strongly associated with remission: the COMET trial. Ann Rheum Dis 69:222–225CrossRefPubMedGoogle Scholar
- 42.Rech J, Hueber AJ, Finzel S, Englbrecht M, Haschka J, Manger B, Kleyer A, Reiser M, Cobra JF, Figueiredo C, Tony HP, Kleinert S, Wendler J, Schuch F, Ronneberger M, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Lorenz HM, Nuesslein H, Alten R, Henes J, Krueger K, Schett G (2016) Prediction of disease relapses by multibiomarker disease activity and autoantibody status in patients with rheumatoid arthritis on tapering DMARD treatment. Ann Rheum Dis 75:1637–1644CrossRefPubMedGoogle Scholar
- 44.Kekow J, Moots R, Khandker R, Melin J, Freundlich B, Singh A (2011) Improvements in patient-reported outcomes, symptoms of depression and anxiety, and their association with clinical remission among patients with moderate-to-severe active early rheumatoid arthritis. Rheumatology (Oxford) 50:401–409CrossRefGoogle Scholar