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