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Prognostic factors for remission in early rheumatoid arthritis: a multiparameter prospective study
  1. L Gossec1,
  2. M Dougados1,
  3. P Goupille2,
  4. A Cantagrel3,
  5. J Sibilia4,
  6. O Meyer5,
  7. J Sany6,
  8. J-P Daurès7,
  9. B Combe6
  1. 1René Descartes University, Cochin Hospital, Department of Rheumatology B, Paris, France
  2. 2Centre Hospitalier Universitaire Tours, Tours, France
  3. 3Centre Hospitalier Universitaire Rangueil, Toulouse, France
  4. 4Centre Hospitalier Universitaire Strasbourg, Strasbourg, France
  5. 5Centre Hospitalier Universitaire Bichat, Paris, France
  6. 6service d’Immuno-Rhumatologie, Centre Hospitalier Universitaire Montpellier, and INSERM U454, Montpellier, France
  7. 7Institut Universitaire de Recherche Clinique, Montpellier, France
  1. Correspondence to:
    Professor Bernard Combe
    Service d’Immuno-Rhumatologie, Hôpital Lapeyronie, 371 Avenue du doyen Gaston Giraud, 34295 Montpellier Cedex 5, France; b-combechu-montpellier.fr

Abstract

Objective: To determine prognostic factors for remission in early rheumatoid arthritis.

Methods: 191 patients with rheumatoid arthritis whose disease duration was less than one year were followed up prospectively for five years. Remission, defined by a disease activity score (DAS) of <1.6, was used as the outcome measure. Baseline clinical, laboratory, genetic, and radiographic data (with radiographic scores determined by Sharp’s method, modified by van der Heijde) were obtained.

Results: 48 patients (25.1%) fulfilled the remission criteria at the three year follow up visit, and 30 (15.7%) at three and five years. On univariate analysis by Fisher’s exact test, remission at three years and persistent remission at five years were closely correlated with baseline DAS values, C reactive protein level, Ritchie score, health assessment questionnaire score, duration of morning stiffness, and to a lesser extent baseline total radiological scores and rheumatoid factor negativity. No significant correlation was found with sex, age, extra-articular manifestations, erythrocyte sedimentation rate, anti-cyclic citrullinated protein antibodies, anti-keratin antibodies, anti-HSP 90, anticalpastatin antibodies, antinuclear antibodies, or HLA-DRB1* genotypes. Logistic regression analysis showed that the baseline independent variables predictive of remission were low DAS, Ritchie score, morning stiffness duration, and total radiographic score.

Conclusions: Baseline prognostic factors for remission in early rheumatoid arthritis were mainly clinical markers of disease activity and radiological scores.

  • rheumatoid arthritis
  • remission
  • prognosis
  • disease activity score
  • ACR, American College of Rheumatology
  • ARA, American Rheumatism Association, DAS, disease activity score
  • DMARD, disease modifying antirheumatic drug
  • HAQ, health assessment questionnaire

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