Achievement of Remission and Low Disease Activity Definitions in Patients with Rheumatoid Arthritis in Clinical Practice: Results from the NOR-DMARD Study

Uhlig, Till; Lie, Elisabeth; Norvang, Vibeke; Lexberg, Åse Stavland; Rødevand, Erik; Krøll, Frode; Kalstad, Synøve; Olsen, I.C.; Kvien, Tore K

doi:10.3899/jrheum.151132

Cited by 23 publications

(11 citation statements)

References 22 publications

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“…The seronegative patients had the highest levels of inflammation at baseline,(7) but these patients had, nevertheless, two-year remission rates comparable to the seropositive patients suggesting good response to modern treatment. (200) Very early arthritis (defined as symptom duration less than three or six months) are highlighted as the most important factor for reaching remission, (73,74,201) and our study supports DMARD initiation within 3 months after symptom onset. As symptom onset was defined as the first swollen joint according to patient memory, there is a chance of recall bias.…”

Section: Prediction Of Sustained Remission In Early Rasupporting

confidence: 70%

Predictors of sustained remission in patients with early rheumatoid arthritis treated according to an aggressive treat-to-target protocol

Olsen

Aga

et al. 2018

Rheumatology

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Section: Prediction Of Sustained Remission In Early Rasupporting

confidence: 70%

Predictors of sustained remission in patients with early rheumatoid arthritis treated according to an aggressive treat-to-target protocol

Olsen

Aga

et al. 2018

Rheumatology

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“…Several prior studies showed that women are less likely to achieve remission when using the DAS28-ESR (1,2,9,14), but there are less consistent findings in studies examining the performance of CDAI and RAPID3 (5,9,14). Our study confirmed that women are less likely to reach remission when defined by the DAS28-ESR.…”

Section: Discussionsupporting

confidence: 54%

“…In a study from the Corrona RA registry, a large prospective cohort study, women were less likely to achieve CDAI early sustained remission , but there was no difference in established remission or in early point remission. Another recent study showed that women were less likely to achieve remission when it was defined by DAS28‐ESR, CDAI, and the Simple Disease Activity Index but found no difference in remission rates for Boolean criteria or RAPID3 . Overall, these studies suggest a more refractory phenotype among women, but the results lack consistency and vary based on the composite outcomes used and population studied.…”

Section: Introductionmentioning

confidence: 99%

“…A recent nationwide survey of US rheumatologists found that the most used outcome measures (functional status and disease activity) in the care of RA patients are the Health Assessment Questionnaire (HAQ) or Multidimensional (MD)‐HAQ (35.5%), the Routine Assessment of Patient Index Data 3 (RAPID3; 27.1%), the Clinical Disease Activity Index (CDAI; 17.5%), and the Disease Activity Score in 28 joints (DAS28; 15.7%) . While a number of disease activity measures are used, studies have shown that the rate of remission depends significantly on the criteria used .…”

Section: Introductionmentioning

confidence: 99%

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Sex Differences in the Achievement of Remission and Low Disease Activity in Rheumatoid Arthritis

Maynard

Mikuls

Cannon

et al. 2020

Arthritis Care & Research

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Objective In rheumatoid arthritis, whether women are less likely to achieve low disease activity is unclear. We evaluated sex differences in remission and low disease activity, comparing different clinical and imaging measures. Methods We used data from the Veterans Affairs Rheumatoid Arthritis (VARA) registry and from 2 clinical trials. Remission and low disease activity were defined using composite scores, individual items (tender joints, swollen joints, erythrocyte sedimentation rate [ESR], C‐reactive protein [CRP] level, and evaluator/patient global assessment), and magnetic resonance imaging (MRI). In the VARA registry, we assessed the likelihood of point remission at any time during follow‐up using logistic regression, and time to sustained remission (2 consecutive visits) using Cox proportional hazards models. In the clinical trials, logistic regression models evaluated the likelihood of low clinical and MRI activity at 52 weeks. Results Among 2,463 patients in VARA, women (10.2%) were less likely to be in Disease Activity Score in 28 joints (DAS28)–ESR remission in follow‐up (odds ratio [OR] 0.71 [95% confidence interval (95% CI) 0.55–0.91]; P < 0.01) and had a longer time to sustained DAS28‐ESR remission. This difference was not observed for DAS28‐CRP, Clinical Disease Activity Index, or Routine Assessment of Patient Index Data 3. Women were more likely to achieve favorable individual components except for an ESR <30 mm/hour (OR 0.72 [95% CI 0.57–0.90]; P < 0.01). Among 353 trial participants (83.7% women), women had reduced rates of DAS28‐ESR remission (OR 0.39 [95% CI 0.21–0.72]; P = 0.003) but similar rates of low MRI synovitis and osteitis. Conclusion The comparison of remission rates between men and women varies based on the disease activity measure, with sex‐specific differences in ESR resulting in reliably lower rates of remission among women. There were no differences in MRI measures.

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“…One plausible reason for this may be that biological treatment in Austria is initiated in patients with milder disease than in other countries [14]. Better outcomes in milder than higher diseased patients are underlined by a recent study conducted in a five-centre Norwegian register [15], as well as in the German register RABBIT, which recorded a 30 % DAS28 remission rate when bDMARD therapy was started in moderate DA [16]. …”

Section: Discussionmentioning

confidence: 99%

Validity of data collected in BIOREG, the Austrian register for biological treatment in rheumatology: current practice of bDMARD therapy in rheumatoid arthritis in Austria

Rintelen

Zwerina

Herold

et al. 2016

BMC Musculoskelet Disord

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BackgroundThe purpose of the present study was to check the validity of data collected in BIOREG, the Austrian register for biological treatment in rheumatology, and to elucidate eventual differences with respect to disease activity (DA) in patients with rheumatoid arthritis (RA) on established biological DMARDs (bDMARDs) before inclusion into the register (EST) and beginners at the time point of inclusion (NEW) after 1 year of treatment.MethodsRA patients with a complete follow-up of 1 year in BIOREG were divided into EST and NEW and compared with respect to DA, remission rates, concomitant synthetic DMARDs (csDMARDs) and glucocorticoid therapy (GC) at baseline and after 1-year follow-up. Safety concerns are listed. Descriptive statistics are applied.ResultsFor 346 RA patients (284 EST, 62 NEW) out of 970 RA patients included into BIOREG, a full data set for a 1-year follow-up was available. No differences in DA were observed after 1 year as expressed by DAS28 or RADAI-5, and small differences as expressed by remission rates according to DAS28, RADAI-5 or Boolean criteria (namely approximately 1/2, 1/3 to 1/4 and 1/4 to 1/5 of the patients respectively). Sixty-four adverse events (AEs) were noted in 56 (20 %) of EST and 20 in 19 (31 %) of NEW patients. Malignancy occurred in four patients. After 1 year, 48 % of EST patients but only 16 % of NEW patients were on bDMARD monotherapy.ConclusionRegarding DA, the date collected in BIOREG appeared to be valid. After 1 year of bDMARD therapy, all patients, whether EST or NEW, achieved a similar level of DA. AEs occurred more frequently during the early phase of bDMARD treatment. Austrian rheumatologists initiate bDMARD therapy in patients with lower disease levels than in other European countries, leading to high remission rates.

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Achievement of Remission and Low Disease Activity Definitions in Patients with Rheumatoid Arthritis in Clinical Practice: Results from the NOR-DMARD Study

Cited by 23 publications

References 22 publications

Predictors of sustained remission in patients with early rheumatoid arthritis treated according to an aggressive treat-to-target protocol

Predictors of sustained remission in patients with early rheumatoid arthritis treated according to an aggressive treat-to-target protocol

Sex Differences in the Achievement of Remission and Low Disease Activity in Rheumatoid Arthritis

Validity of data collected in BIOREG, the Austrian register for biological treatment in rheumatology: current practice of bDMARD therapy in rheumatoid arthritis in Austria

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