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Prognostic factors for remission in early rheumatoid arthritis: a multiparameter prospective study

L Gossec¹, M Dougados¹, P Goupille², A Cantagrel³, J Sibilia⁴, O Meyer⁵, J Sany⁶, J-P Daurès⁷, B Combe⁶

¹ René Descartes University, Cochin Hospital, Department of Rheumatology B, Paris, France
² Centre Hospitalier Universitaire Tours, Tours, France
³ Centre Hospitalier Universitaire Rangueil, Toulouse, France
⁴ Centre Hospitalier Universitaire Strasbourg, Strasbourg, France
⁵ Centre Hospitalier Universitaire Bichat, Paris, France
⁶ service d’Immuno-Rhumatologie, Centre Hospitalier Universitaire Montpellier, and INSERM U454, Montpellier, France
⁷ Institut Universitaire de Recherche Clinique, Montpellier, France

Correspondence to:
Correspondence to:
Professor Bernard Combe
Service d’Immuno-Rhumatologie, Hôpital Lapeyronie, 371 Avenue du doyen Gaston Giraud, 34295 Montpellier Cedex 5, France; b-combe{at}chu-montpellier.fr

Objective: To determine prognostic factors for remission in early rheumatoid arthritis.

Methods: 191 patients with rheumatoid arthritis whose disease duration was less than one year were followed up prospectively for five years. Remission, defined by a disease activity score (DAS) of <1.6, was used as the outcome measure. Baseline clinical, laboratory, genetic, and radiographic data (with radiographic scores determined by Sharp’s method, modified by van der Heijde) were obtained.

Results: 48 patients (25.1%) fulfilled the remission criteria at the three year follow up visit, and 30 (15.7%) at three and five years. On univariate analysis by Fisher’s exact test, remission at three years and persistent remission at five years were closely correlated with baseline DAS values, C reactive protein level, Ritchie score, health assessment questionnaire score, duration of morning stiffness, and to a lesser extent baseline total radiological scores and rheumatoid factor negativity. No significant correlation was found with sex, age, extra-articular manifestations, erythrocyte sedimentation rate, anti-cyclic citrullinated protein antibodies, anti-keratin antibodies, anti-HSP 90, anticalpastatin antibodies, antinuclear antibodies, or HLA-DRB1* genotypes. Logistic regression analysis showed that the baseline independent variables predictive of remission were low DAS, Ritchie score, morning stiffness duration, and total radiographic score.

Conclusions: Baseline prognostic factors for remission in early rheumatoid arthritis were mainly clinical markers of disease activity and radiological scores.

Keywords: rheumatoid arthritis; remission; prognosis; disease activity score

Abbreviations: ACR, American College of Rheumatology; ARA, American Rheumatism Association, DAS, disease activity score; DMARD, disease modifying antirheumatic drug; HAQ, health assessment questionnaire

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