Background Modern rheumatoid arthritis (RA) care is based on early DMARD initiation, tight control and treat-to-target strategies aiming for abrogation of inflammation to optimize long term outcomes. However, even in the most aggressive treatment studies a substantial proportion of patients do not reach sustained remission.
Objectives We aimed to identify predictors of not reaching sustained DAS remission in early RA patients followed by a treat-to-target algorithm with pre-specified DMARD adjustments.
Methods RA patients who fulfilled the ACR/EULAR 2010 classification criteria, with <2 years from first swollen joint and who were DMARD naïve with indication for DMARD treatment were included in the ARCTIC trial between 2010 and 2013. Patients were followed by a structured tight control algorithm aiming for a target of DAS<1.6 and no swollen joints, and in half the patients the treatment target also included no joints with ultrasound power-Doppler signal. For patients with established risk factors for joint destruction (ACPA or RF positive with radiographic erosions or MRI bone marrow edema at baseline) treatment could be escalated more rapidly to biologic therapy. Data collection included 44 SJC, Ritchie articular index (RAI), laboratory tests, patient reported outcomes, ultrasound examination and radiographs. Multivariate logistic regression was used to assess the associations between baseline variables and not being in sustained DAS remission at 16 to 24 months. A univariate p-value of <0.25 was used for variable selection, and a p-value of <0.05 to keep the variable in the model. Patient reported physical function and physician global were not included in the model building because of collinearity.
Results A total of 221 patients were included, with mean [SD] age 51.1 [13.7] years, disease duration 7.2 [5.4] months, DAS 3.5 [1.2]. 63% were female, 72% RF- and 82% ACPA positive, and 16% escalated treatment more rapidly to biologic therapy. 103 (47%) did not reach sustained DAS remission between 16 and 24 months. Tender joints assessed by RAI (OR 1.11 per unit, p<0.001) and BMI (OR 1.07 per unit, p=0.046) were independent predictors for not reaching sustained DAS remission.
Conclusions In early RA patients treated by an aggressive treat-to-target strategy, tender joints assessed by Ritchie articular index and BMI at time of diagnosis were independent predictors for not reaching sustained DAS remission. Our results are supported by previous studies indicating that overweight decreases the chance of achieving treatment success in early RA (1).
Sandberg ME et al. ARD 2014;73(11):2029–33.
Disclosure of Interest None declared