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Sex: a major predictor of remission in early rheumatoid arthritis?
  1. K Forslind1,
  2. I Hafström2,
  3. M Ahlmén3,
  4. B Svensson4,
  5. for the BARFOT Study Group
  1. 1Section of Rheumatology, Helsingborgs Lasarett, Helsingborg, Sweden
  2. 2Rheumatology Department, Karolinska University Hospital Huddinge, Stockholm, Sweden
  3. 3Rheumatology Department, Sahlgrenska University Hospital/Mölndal, Sweden
  4. 4Rheumatology Department, University Hospital, Lund, Sweden
  1. Correspondence to:
    Björn Svensson
    Blistorpsvägen 546, 290 38 Villands Vånga, Sweden; bjosve{at}telia.com

Abstract

Background: The treatment goal of early rheumatoid arthritis is remission. This study reports remission rates in clinical practice using a cohort of patients with early rheumatoid arthritis.

Methods: 698 patients with early rheumatoid arthritis were included. Mean age at inclusion was 58 years and mean disease duration was 6.4 months; 64% of the patients were women, 56% were positive for antibodies to cyclic citrullinated peptide and 60% were positive for rheumatoid factor. Remission was defined as a disease activity score <2.6, with or without ongoing treatment with drugs for rheumatoid arthritis.

Results: After 2 years, 261 of 689 patients were in remission (37.9%), and after 5 years, the remission rate was 38.5%. However, only 26.1% were in remission at both these time points. Multiple logistic regression analyses found sex to be a main predictor for remission. Thus, significantly fewer women were in remission after 2 years (32.1% v 48%, p = 0.001) after 5 years (30.8% v 52.4%, p = 0.001) and at both these time points (19.1% v 39.3%, p = 0.001). Although disease activity was not with certainty more pronounced in women at onset of disease, the disease course became markedly worse in women. The disparity in remission frequency between women and men could not be explained by differences in disease duration, age or treatment with disease modifying antirheumatic drugs or glucocorticoids.

Conclusions: Early remission of rheumatoid arthritis by 28-joint Disease Activity Score<2.6 was as frequent or more frequent in this study than in most previous reports. Importantly, women had more severe disease with a considerably lower remission rate than men, although the disease activity before treatment seemed similar.

  • anti-CCP, antibodies to cyclic citrullinated peptide
  • ARA, American Rheumatism Association
  • BARFOT, Better Anti-Rheumatic FarmacOTherapy
  • CRP, C reactive protein
  • DAS28, 28-joint Disease Activity Score
  • DMARDs, disease-modifying antirheumatic drugs
  • ESR, erythrocyte sedimentation rate
  • HAQ, Health Assessment Questionnaire
  • SOFI, Signals Of Functional Impairment

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Footnotes

  • Funding: This study has been supported by grants from The Swedish Rheumatism Association, King Gustaf V 80 year’s Foundation, the Gorthon Foundation in Helsingborg and Stiftelsen för Rörelsehindrade i Skåne.

  • Competing interests: None declared.

  • The BARFOT study group: Monica Ahlmén, Johan Bratt, Kristina Forslind, Ingiäld Hafström, Catharina Keller, Ido Leden, Bengt Lindell, Ingemar Petersson, Björn Svensson, Annika Teleman and Jan Theander.

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