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Clinical Rheumatology

, Volume 37, Issue 3, pp 597–605 | Cite as

Remission assessment of rheumatoid arthritis in daily practice in China: a cross-sectional observational study

  • Huaqun Zhu
  • Ru Li
  • Zhanyun Da
  • Liqi Bi
  • Xiangpei Li
  • Yang Li
  • Chongyang Liu
  • Fengxiao Zhang
  • Zhijun Li
  • Xiangyuan Liu
  • Zhiyi Zhang
  • Lingyun Sun
  • Youlian Wang
  • Wei Zhang
  • Quan Jiang
  • Jinwei Chen
  • Qingping Chen
  • Zhenbin Li
  • Lijun Wu
  • Wencheng Qi
  • Jianhua Xu
  • Xiangjun Cui
  • Xiaofei Wang
  • Long Li
  • Xiaomei Leng
  • Guochun Wang
  • Dongbao Zhao
  • Lindi Jiang
  • Dongyi He
  • Xiaomin Liu
  • Ling Li
  • Yongfei Fang
  • Cibo Huang
  • Huaxiang Wu
  • Shaoxian Hu
  • Qin Li
  • Hui Song
  • Weiguo Xiao
  • Lu Gong
  • Liaojia Zhang
  • Xiaofeng Li
  • Zhanguo Li
  • Yin Su
Original Article

Abstract

The objective of this study is to evaluate the remission rate and describe the current use of medication in a large cohort of rheumatoid arthritis (RA) patients under routine clinical care in China. RA patients were recruited from 40 large teaching hospitals nationwide in China. Data regarding RA disease activity, medication treatment, and adverse events were recorded using a standardized clinical data questionnaire. RA remission was evaluated by the 28 Joint Disease Activity Score DAS28-ESR Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria. A total of 1945 patients with RA were included in the study. The proportions of patients who fulfilled the DAS28-ESR, CDAI, SDAI, and ACR/EULAR remission criteria were 10.90%, 6.17%, 5.04% , and 1.75%, respectively. Most patients had taken at least one disease-modifying anti-rheumatic drug (DMARD), and the most common prescriptions included leflunomide (LEF) and methotrexate (MTX). DMARD combined with botanics were the most common and dominant strategy for RA management (29.16%). Overall, 433 patients (22.27%) had at least one adverse event. Gastrointestinal adverse events (41.27%) were the most frequently reported events. The incidence of side effects in patients using biologics DMARDs (bDMARDs) was significantly lower than that in those taking MTX, LEF, or sulfasalazine (SSZ). The remission rate of RA disease activity, as assessed in Chinese clinical practice, was very low. Adverse effects of the medicine occurred in approximately one in five RA patients, with bDMARDs were demonstrated to be the medication with the lowest side effects.

Keywords

Adverse events DMARDs Disease activity Medical options Rheumatoid arthritis 

Abbreviations

RA

rheumatoid arthritis

DMARDs

disease-modifying anti-rheumatic drugs

GCs

glucocorticoids

CDAI

Clinical Disease Activity Index

SDAI

Simplified disease Activity Index

EULAR

European League Against Rheumatism

ACR

American College of Rheumatology

HAQ

Health Assessment Questionnaire Disability Index

LEF

leflunomide

MTX

methotrexate

HCQ

hydroxychloroquine

SSZ

sulfasalazine

TLM

thalidomide

CTX

cyclophosphamide

AZA

azathioprine

MMF

mycophenolate mofetil

CsA

cyclosporin A

Min

minocycline

D-P

penicillamine

ETN

etanercept

IFX

infliximab

ADA

adalimumab

RTX

rituximab

Pred

prednisone

MP

methyl prednisolone

DPS

diprospan

DXM

dexamethasone

TGP

total glucosides of Paeonia

TGV

Tripterygium glycosides

Sin

sinomenine

MCP

metacarpophalangeal

PIP

proximal interphalangeal

MTP

metatarsophalangeal

DIP

distal interphalangeal

SJC

swollen joint count

TJC

tender joint count

Notes

Acknowledgments

The authors would like to thank all participating patients, study nurses, and all colleagues.

Authors’ contributions

Huaqun Zhu and Ru Li performed most of the research. Yin Su and Zhanguo Li conceived the study and participated in the design and in the interpretation of results. All authors participated in the study conception and design and participated in the acquisition of data, and analysis and interpretation of data. All authors read and approved the manuscript.

Funding

This work was supported by grants from the National Natural Science Foundation of China (81172844, 81471600, 31530020, and 81120108020) and the National Sci-Tech Support Program (2008BAI59B01 and 2014BAI07B01).

Compliance with ethical standards

Ethics approval and consent to participate

The study was approved by the Institutional Medical Ethics Review Board of Peking University People’s Hospital. The participants gave informed consent to participate.

Consent for publication

All authors have read and approved the final version of the manuscript for publication.

Disclosures

None.

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2017

Authors and Affiliations

  • Huaqun Zhu
    • 1
    • 2
    • 3
  • Ru Li
    • 1
    • 2
    • 3
  • Zhanyun Da
    • 4
  • Liqi Bi
    • 5
  • Xiangpei Li
    • 6
  • Yang Li
    • 7
  • Chongyang Liu
    • 8
  • Fengxiao Zhang
    • 9
  • Zhijun Li
    • 10
  • Xiangyuan Liu
    • 11
  • Zhiyi Zhang
    • 12
  • Lingyun Sun
    • 13
  • Youlian Wang
    • 14
  • Wei Zhang
    • 15
  • Quan Jiang
    • 16
  • Jinwei Chen
    • 17
  • Qingping Chen
    • 18
  • Zhenbin Li
    • 19
  • Lijun Wu
    • 20
  • Wencheng Qi
    • 21
  • Jianhua Xu
    • 22
  • Xiangjun Cui
    • 23
  • Xiaofei Wang
    • 24
  • Long Li
    • 25
  • Xiaomei Leng
    • 26
  • Guochun Wang
    • 27
  • Dongbao Zhao
    • 28
  • Lindi Jiang
    • 29
  • Dongyi He
    • 30
  • Xiaomin Liu
    • 31
  • Ling Li
    • 32
  • Yongfei Fang
    • 33
  • Cibo Huang
    • 34
  • Huaxiang Wu
    • 35
  • Shaoxian Hu
    • 36
  • Qin Li
    • 37
  • Hui Song
    • 38
  • Weiguo Xiao
    • 39
  • Lu Gong
    • 40
  • Liaojia Zhang
    • 41
  • Xiaofeng Li
    • 42
  • Zhanguo Li
    • 1
    • 2
    • 3
  • Yin Su
    • 1
    • 2
    • 3
  1. 1.Department of Rheumatology and ImmunologyPeking University People’s HospitalBeijingChina
  2. 2.Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
  3. 3.Peking-Tsinghua Center for Life SciencesBeijingChina
  4. 4.Affiliated Hospital of Nantong UniversityNantongChina
  5. 5.China-Japan Union Hospital of Jilin UniversityChangchunChina
  6. 6.Anhui Provincial HospitalHefeiChina
  7. 7.The Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
  8. 8.Daping Hospital, Research Institute of SurgeryThird Military Medical UniversityChongqingChina
  9. 9.Hebei General HospitalShijiazhuangChina
  10. 10.The First Affiliated Hospital of Bengbu Medical CollegeBengbuChina
  11. 11.Peking University Third HospitalBeijingChina
  12. 12.The First Affiliated Hospital of Harbin Medical UniversityHarbinChina
  13. 13.Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
  14. 14.Jiangxi Provincial People’s HospitalNanchangChina
  15. 15.The Fifth Department of Rheumatology, Xi’an No. 5 HospitalXi’anChina
  16. 16.Guang’anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
  17. 17.The Second Xiangya Hospital of Central South UniversityChangshaChina
  18. 18.The First Department of Rheumatology, Xi’an No.5 HospitalXi’anChina
  19. 19.Bethune International Peace HospitalShijiazhuangChina
  20. 20.People’s Hospital of Xinjiang Uygur Autonomous RegionXinjiangChina
  21. 21.Tianjing First Center HospitalTianjinChina
  22. 22.The First Affiliated Hospital of Anhui Medical UniversityHefeiChina
  23. 23.Yichang Central People’s HospitalYichangChina
  24. 24.Shengjing Hospital of China Medical UniversityShenyangChina
  25. 25.The Affiliated Hospital of Guiyang Medical UniversityGuiyangChina
  26. 26.Peking Union Medical College HospitalBeijingChina
  27. 27.China-Japan Friendship HospitalBeijingChina
  28. 28.Changhai HospitalShanghaiChina
  29. 29.Zhongshan HospitalShanghaiChina
  30. 30.Guanghua HospitalShanghaiChina
  31. 31.The Hospital of Shunyi District BeijingShunyi DistrictChina
  32. 32.Tianjin People’s HospitalTianjinChina
  33. 33.South West HospitalThird Military Medical UniversityChongqingChina
  34. 34.Beijing HospitalBeijingChina
  35. 35.The Second Affiliated Hospital Zhejiang University School of MedicineHangzhouChina
  36. 36.Tongji Hospital, Tongji Medical College of HustTongji College Huazhong University Science & TechnologyWuhanChina
  37. 37.The First People’s Hospital of Yunnan ProvinceKunmingChina
  38. 38.Beijing Jishuitan HospitalBeijingChina
  39. 39.The First Hospital of China Medical UniversityShenyangChina
  40. 40.Tianjing Medical University General HospitalBeijingChina
  41. 41.Jiangsu Province HospitalNanjingChina
  42. 42.The Second Hospital of Shanxi Medical UniversityTaiyuanChina

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