Early disease activity suppression and younger age predict excellent outcome of recent-onset rheumatoid arthritis patients treated with conventional disease modifying anti-rheumatic drugs

Clin Exp Rheumatol. 2012 May-Jun;30(3):402-8. Epub 2012 Jun 26.

Abstract

Objectives: Sustained remission (SR) is the target of treatment offered to patients with rheumatoid arthritis (RA). The objective of the present paper is to describe predictors of favourable outcomes in a cohort of early RA patients.

Methods: Data from 89 patients with 3 years of consecutive assessments and traditional treatment were analysed. SR was defined as ≥ 6 consecutive months with 2011 ACR/EULAR remission criteria. Excellent outcome (EO) was defined according to patient's perception. Descriptive statistics, logistic regression models and Cox regression were used.

Results: At baseline, patients were predominantly females (n=78), had rheumatoid factor (n=70) and (mean ± SD) age of 38.8 ± 13.6 years. After (mean ± SD) 37.1 ± 2.5 months, 75 patients achieved ≥ 1 SR state and 35 an EO. The former had lower disease activity, disability and comorbidity and better functional status at baseline than their counterparts (p ≤ 0.05); they also accumulated lesser disability (p ≤ 0.03). Lower C-reactive protein and disease activity and lesser comorbidity predict SR (p ≤ 0.04). Patients with EO were younger, better educated, had lower disease activity, better functional status and lesser comorbidity at baseline than their counterparts (p ≤ 0.05). They achieved a first sustained remission state (p ≤ 0.001) sooner and accumulated lesser disability and incident erosive disease (p ≤ 0.002). Younger age and lower disease activity were prognosticators of EO (p ≤ 0.02). When age, baseline disease activity and time to first SR were investigated as predictors of EO, younger age (HR:0.95, 95% CI: 0.91-0.98, p=0.003) and earlier SR (HR:0.49, 95% CI: 0.39-0.61, p ≤ 0.001) were relevant.

Conclusions: Younger patients with lower disease activity achieved earlier SR which, in addition to age, was predictor of EO.

MeSH terms

  • Adult
  • Age Distribution
  • Age of Onset
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / epidemiology*
  • Comorbidity
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Risk Factors
  • Severity of Illness Index*
  • Treatment Outcome

Substances

  • Antirheumatic Agents