Background A prolonged disease duration is associated to a lower chance to achieve disease remission in rheumatoid arthritis. Onset of the disease can be defined in a number of ways and, when possible, the following data should be recorded: 1) first musculoskeletal (MSK) symptoms relevant to the current compliant 2) first persistent patient-reported joint swelling 3) initial fulfilment of criteria for RA based on data obtained retrospectively1.
Objectives The aim of this study was to identify the variables associated with ACR/EULAR remission2 in a cohort of early rheumatoid arthritis (ERA). In particular, the different types of disease onset, as defined1, were investigated.
Methods All the patients, referred to the Early Arthritis Clinic of the University Rheumatology Clinic of Udine between October 2013 and October 2015, with a diagnosis of RA and fulfilling ACR/EULAR 2010 criteria, were included. The EULAR recommendations for treat to target were followed. At the first visit, 13 clinical and laboratory variables associated with RA, including the different type of onset1, were recorded. The variables associated with remission at the 12th month (+12) of therapy by univariate analyses were included in a multivariate logistic regression model. Receiver operator characteristic (ROC) curves were used to evaluate the discriminative capability of the different types of onset.
Results Ninety-two patients with ERA were assessed and 65 completed 12-month evaluation. 15/65 (23,1%) reached ACR/EULAR remission at +12. Two variables were selected in the logistic regression analysis (i.e. BMI and time to fulfilment of ACR/EULAR classification criteria). A low BMI (OR 0,54; CI 95% 0,33 to 0,86; p=0,01) predicted remission and 23,5 being the optimal BMI cut-off value. Time to fulfilment of ACR/EULAR classification criteria for RA was also significantly associated with remission at +12 (OR 0,21; CI 95% 0,05–0,92; p=0,039) and 2,5 months was the cut-off value showing the best discriminative power for remission achievement. By contrast, a shorter time from the onset of MSK symptoms (5.5 months showing the best discriminative power) was selected only by univariate analysis.
Conclusions From a clinical perspective the present preliminary data may be reassuring if confirmed by larger analyses: a shorter time from the fulfilment of ACR/EULAR classification criteria of RA, when treatment has been frequently started (thus, not necessarily the time from the onset of MSK symptoms) is associated with disease remission at +12 in ERA. From a biologic point of view, starting the treatment as soon as disease begins (i.e. onset of MSK symptoms) may be more effective, but the currently available prognostic, diagnostic and treatment tools do not allow this recommendation yet. Furthermore remission is related to BMI, since patients with BMI >24 showed a lower chance to achieve remission
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Disclosure of Interest None declared