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THU0094 Factors associated with radiographic remission (RR) in patients with rheumatoid arthritis (RA) while non-biologicaldisease modifying anti-rheumatic drugs (DMARDS) using
  1. O Iaremenko,
  2. G Mykytenko
  1. Internal Diseases at Stomatological Faculty, O.O. Bogomolets National Medical University, Kyiv, Ukraine

Abstract

Objectives To assess the factors associated with RR achievement in patients (pts) with RA while non-biological DMARDs using.

Methods A cohort of 174 pts with RA (50.6% with early RA) was prospectively assessed at baseline and 2 years by the Disease Activity Score (DAS28) and the Sharp–van der Heijde Score (SHS). Mean age at inclusion was 52.0±0.91 yrs, disease duration – 51.3±4.82 month. 82.7% of the pts were women; 62.6% were positive for rheumatoid factor (RF) and 75.9% - for antibodies against cyclic citrullinated peptides (aCCP). Pts were treated with methotrexate (MTX) (mean dose – 11.6±0.29 mg/w, n=157), leflunomide (LF) (19.2±0.28 mg/d, n=95), sulfasalazine (SS) (2 g/d, n=76) or combination of DMARDs (CD) (n=74). After 2 yrs of DMARDs therapy 41 pts (23.5%) reached RR (ΔSHS≤0.5). No one pts using low dose of MTX (7.5 mg/week) achieved remission so they were excluded from further analysis. According to RR achievement in 2 yrs pts were divided into 2 groups (41and 92 pts who achieved RR and didn't respectively). After 2 yrs the factors associated with RR achievement in pts with RA while non-biological DMARDs using were assessed.

Results Before study, pts in both groups were comparable by all demographic, clinical and X-ray characteristics, frequency of DMARDs prescribed. They differed only in frequency of RF-positivity (39.0 and 57.6% respectively in pts achieved RR and didn't, p<0.05), aCCP-positivity (21.7 and 73.3% respectively, p<0.001) and aCCP level (6.06±0.88 and 105.3±22.7 U/ml respectively, p<0.001).

There was strong and moderate positive correlation between RR achivement and aCCP-negativity (r=0.57, p<0.05), low aCCP level (r=0.45, p<0.05) and ΔDAS28 (r=0.35, p<0.05).

Results of multinomial logistic regression analyses (SPSS, V.22, IBM) showed that RF-negativity was the only independent predictor of RR achievement (B=3.14, p<0.05).

41.7% pts in RR achieved clinical remission by DAS28 as well. Only 19.7% pts achieved clinical remission without RR (p<0.05 vs pts achieved clinical and RR) and 12.5% pts achieved RR without clinical response (DAS28>5.1, ΔDAS28≤1.2 or any value of DAS28 with ΔDAS28≤0.6; p<0.01).

After 2 years of treatment the mean value of ΔDAS28 in comparison groups (with and without RR) did not differ (2.79±0.28 vs 2.33±0.17 respectively) so there was a discrepancy between clinical and radiological outcome.

Conclusions Baseline predictors associated with achieving of radiographic remission in pts with RA are RF- and aCCP-negativity, low level of aCCP, but independent predictor of radiographic remission achievement is the only RF-negativity.

The discrepancy between the frequency of clinical and radiographic remission achievement in RA patients is observed.

After 2 yrs of non-biological DMARDs treatment 41.7% pts with RA achieves radiographic and clinical remission at the same time.

Disclosure of Interest None declared

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