Background The aim of early RA treatment is remission. Intensive treatment with MTX achieve remission in 30–50% patients (pts). Modifiable risk factors, as smoking, alcohol, coffee and tea, may affect response to MTX.
Objectives To study the influence of tobacco, alcohol, caffeine on the MTX response in early RA pats.
Methods A case-control study (2010–2015): cases were pts who achieved DAS28<2.6 (remission) and controls were pts who did not. We collected information from pts>18years with early RA, treated with MTX, evaluated quarterly in a specialized unit early RA. All the pts underwent a structured interview about their smoking history and others habits. A descriptive and comparative study, was performed (SPSS21).
Results 182 pts (age 50,96±13,11y, 67,6% female, 81,3% FR+ and 65,7% ACPA+) was treated with MTX and followed 105,03±7,15 months since 1995. More than 95% pts received MTX (in rapid escalation) in the first 24 months of the onset of symptoms. DAS28<2.6 was achieved for 67 (36,8%) pts, who required an lower average dose of MTX (15,07mg/w) than those who did not (18,04mg/w) (p=0,000). Age, DAS28 and physical function at baseline, treatment delay, smoking and adverse events by MTX were related to remission.The univariate and multivariate analysis of the baseline pts characteristics and the relationship of their smoking history with age, RF, ACPA and outcome of MTX monotherapy are shown in table 1and 2, respectively. The median survival of MTX monotherapy was 87,39 months (100.27 non-smokers and 47.70 months for current smokers (Log Rank 10.32, p 0.001) (see graphic).
Conclusions The treatment of early RA with MTX alone achieved high rates of remission, especially in non-smokers. Smoking cessation could significantly improve the response to MTX and therefore should be an integral part of the treatment of early RA patients.
Söderlin, et al. Scandinavian Journal of Rheumatology. 2011;40(4):249–55.
Disclosure of Interest None declared
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