Background The new ACR/EULAR remission criteria were developed to identify patients with good outcomes, among early arthritis (EA) patients . It has been hypothesized that patient-reported symptoms and in particular patient global, is often a limiting factor to reaching ACR/EULAR remission . Furthermore, fatigue is an important symptom for patients, but is it predictive?
Objectives To determine if patient global and fatigue over the first year of EA disease course, play a significant role in comparison to other ACR/EULAR remission components, in predicting a hard outcome, structural progression, over 3 years.
Methods Study design: the ESPOIR observational study. Patients: EA (at least 2 swollen joints for <6 months). Definitions of remission: (a) ACR/EULAR Boolean remission at both the 6 month and 12 month visits (i.e., tender and swollen joint counts ≤1, CRP≤1 mg/dl, and patient global ≤1/10), (b) near-remission at the same timepoints, defined as remission for 3 of the 4 criteria (all criteria except patient global), and (c) fatigue-remission at the same points, defined as near-remission AND fatigue, ≤1/10 on a visual analog scale. Outcome: change in total Sharp-van der Heijde score between baseline and at 3 years. Analysis: kappa agreement statistics between the definitions of remission, and predictive capacities of the 3 remissions by multiple linear regression, adjusted on baseline radiographic score. Models were compared by various characteristics: R2 (should be maximal), C(p) (should be closest to 2 in this case), AIC and BIC (should be minimal). Furthermore, a stepwise selection was performed to explain the outcome, including near remission, patient global and fatigue. There was no imputation of missing data.
Results Of the 776 patients, 57 patients (7.4%) were in ACR/EULAR remission both at 6 and 12 months, whereas 145 patients (18.7%) reached near-remission and only 24 patients (3.1%) reached fatigue-remission. Agreement between ACR/EULAR remission and the other definitions was moderate: kappa, 0.51 (95% CI, 0.43-0.60) and 0.39 (0.26-0.53) respectively. Prediction of radiographic progression was similar in all models, but appeared maximal in the models with near-remission and ACR/EULAR remission (table). In stepwise selection only near-remission was predictive.
Conclusions Near-remission is much more frequent than ACR/EULAR remission in EA. It appears from this analysis that near-remission (not taking into account patient global) predicts radiographic progression over 3 years in EA, as well as ACR/EULAR remission. Near-remission may be a valid and even a sufficient predictive outcome in EA.
Felson DT et al. Ann Rheum Dis 2011; 70(3):404-13.
Vermeer M et al. Arthr Rheum 2011, ACR Congress, abstract 2459
Disclosure of Interest None Declared