Background The relevant elements to evaluate health states in RA should include : a) Remission according to the new criteria of ACR/EULAR b) A criterion representing good functional ability: HAQ≤0.5 and HAQ deterioration≤0.25 c) A criterion representing structural damage: absence of progression of the Sharp score over 1 year.
The concept of favorable outcome could then be defined by the association of these 3 elements. As remission is highly related to therapy, we may propose an alternative definition of favorable outcome keeping only the last 2 criteria (function and structure).
Objectives 1) To describe patients with sustained favorable outcome according to the two definitions (using 2 and 3 criteria) over 3 years in EA 2) To assess which variables at baseline are associated with sustained favorable outcome
Methods - Patients: from the French cohort of EA ESPOIR (at least 2 swollen joints for less than 6 months and suspicion of RA) and fulfilling the new ACR-EULAR criteria for RA at baseline. - Data collected: at baseline, patients characteristics; every 6 months, bio-clinical variables and yearly, X-rays. - Analysis: We considered favorable outcome at 1, 2, and 3 years, (using 2 and 3 criteria) associated with a score of 1 point each. We considered 2 definitions of sustained favorable outcome 1) sum of the score of the 3 time-points, 2) weighting using continuity reward (conrew) , with an additional point given for sustained favorable outcome at 2 consecutive time-points. Multinomial and ordinal logistic regression were used to determine which variables at baseline were independently associated with sustained favorable outcome according to the 2 definitions (sum and conrew).
Results Among 813 RA patients, 641 fullfilled the new ACR-EULAR criteria for RA at baseline. In all, 97 and 29 presented favorable outcome at least at 2 time-points using 2 and 3 criteria, respectively (table). In the logistic regression models, lower age and living with a partner (being married/in a common-law relationship) were always associated with sustained favorable outcome using the 3 criteria whatever the definition used (sum or conrew). Absence of ACPA for the sum model and lower tender joint count, lower DAS28 and lower HAQ for the conrew model were also associated with sustained favorable outcome using the 3 criteria. Lower HAQ, absence of ACPA and morning stiffness duration>60 min were always associated with sustained favorable outcome using the 2 criteria whatever the definition used. For the sum model, being male, lower age and lower fatigue were also associated with sustained favorable outcome.
Conclusions Being younger and living with a partner are important determinants of sustained favorable outcome using the 3 criteria (clinical remission+function+structural damage) in early RA. Non-disease related variables should be taken into account in early RA.
Felson DT et al. Ann Rheum Dis 2011;70:404-13
Boers M, et al. J Clin Epidemiol. 2010;63:633-7
Disclosure of Interest None Declared
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