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The impact of different criteria sets on early remission and identifying its predictors in rheumatoid arthritis: results from an observational cohort (2009–2018)

  • Wenhui Xie
  • Ji Li
  • Zhuoli ZhangEmail author
Original Article

Abstract

Objectives

To assess rates of early remission and investigate the concordance across different remission definitions, and to identify predictors of early remission in Chinese patients with rheumatoid arthritis (RA).

Methods

For this study, clinical records were retrospectively reviewed for RA patients at rheumatologic clinic in Peking University First Hospital from 2009 to 2018. Disease activity and remission were determined according to DAS28-ESR, CDAI, SDAI, and Boolean criteria. Early remission was defined as time to remission ≤ 6 months. A secondary definition evaluated early remission as ≤ 3 months. Logistic-regression analyses were performed to identify determinants of early remission.

Results

A total of 869 consecutive patients contributing 8640 clinic visits were studied. Early remission rates were respectively 42.0% (DAS28-ESR), 25.0% (CDAI), 29.4% (SDAI), and 26.1% (Boolean). Notably, patients achieving remission within 6 months more frequently attained sustained remission in contrast to those not achieving early remission (68.7–75.1% vs. 31.2–33.1%, p < 0.0001). Further logistic-regression analyses revealed male, early RA, as well as initial hydroxycloroquine treatment were independently associated higher probability of early remission, as demonstrated by nearly all definitions, while a higher baseline disease activity (DAS28-ESR, CDAI, and SDAI) lowered the possibility of early remission in corresponding remission indices. The significant associations of treatment-naïve, serological features with early remission were not confirmed.

Conclusions

Early remission was strongly associated with sustained remission, however. infrequently achievable in real-life practice. Male, early RA, a low baseline disease activity, and initial hydroxycloroquine treatment were stable independent predictors of early remission.

Key Points

Early remission was infrequently achievable in real-life practice, especially measured by stringent indices.DAS28-based early remission appears to be the loosest criterion and the remaining three broadly agreed with each other.

Early remission was significantly associated with sustained remission.

Male, early RA, a low baseline disease activity, and initial hydroxycloroquine treatment were positively correlated with early remission.

Keywords

Clinical monitoring Outcomes Predictors Remission Rheumatoid arthritis 

Abbreviations

RA

rheumatoid arthritis

DAS28-ESR

disease activity score in 28 joints using erythrocyte sedimentation rate level

CDAI

the clinical disease activity index

SDAI

the simplified disease activity index

ACR

American College of Rheumatology

EULAR

European League Against Rheumatism

RF

rheumatoid factor

CCP

cyclic citrullinated peptides

TJC28

tender joint counts based on 28 joints

SJC28

swollen joint counts based on 28 joints

PGA

patient’s global assessment of disease

EGA

evaluator’s global assessment of disease

DMARDs

disease-modifying antirheumatic drugs

MTX

methotrexate

HCQ

hydroxychloroquine

LEF

leflunomide

SSZ

sulfasalazine

GCs

glucocorticoids

CI

confidence intervals

OR

odds ratio

Notes

Acknowledgments

Authors wish to thank all the patients, rheumatology nurses, and rheumatologists who contributed to our study.

Funding

This work was supported by the National Nature Science Foundation of China (81771740) and Beijing Natural Science Foundation (7184251).

Compliance with ethical standards

Disclosures

None.

Authors consent

The manuscript must be read and approved by all of the authors.

Ethical committee approval

This study was approved by the Ethics Committee of Peking University First Hospital.

Supplementary material

10067_2019_4807_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 21 kb)

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Department of Rheumatology and Clinical ImmunologyPeking University First HospitalBeijingChina

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