Clinical Characteristics of Rheumatoid Arthritis Patients Achieving Functional Remission with Six Months of Biological DMARDs Treatment

Abstract

Objective Although previous studies have reported the prognostic factors for functional remission, no reports have cited the predictive factors. Our aim was to study the predictive factors for functional remission, which is a treatment goal in rheumatoid arthritis (RA), after receiving biological disease-modifying antirheumatic drugs (bDMARDs) treatment for six months. Methods The study consisted of 333 RA patients treated with bDMARDs for six months. The following patient characteristics were investigated: age, gender, disease duration, type of bDMARDs, baseline steroid and methotrexate dosage, and levels of serum rheumatoid factor, matrix metalloprotease, anti-cyclic citrullinated peptides antibody, tumor necrosis factor-α, and interleukin-6. In our evaluation, we used the Simplified Disease Activity Index (SDAI) for RA disease activity, health assessment questionnaire disability index (HAQ-DI) for activity of daily living, Short Form (SF)-36 for quality of life, and Hamilton Depression Rating Scale (HAM-D) or Self-rating Depression Scale (SDS) to determine the patients' depression status. The subjects were divided into two groups: patients with HAQ-DI≤0.5 and HAQ-DI>0.5 at 6 months. Results A univariate analysis comparing a group of RA patients without functional remission (n=68) showed that the patients with functional remission (n=164) had the following in common compared with those without remission: younger age, shorter disease duration, lower baseline steroid dosage, lower SDAI, lower HAQ-DI, higher SF-36, and lower HAM-D. Only lower HAQ-DI scores and “mental health” score on the SF-36 were detected using a logistic regression analysis. Conclusion These findings suggested that RA patients with lower HAQ-DI and lower depression scores at baseline were more likely to achieve functional remission using bDMARDs treatment than those without these variables.

The Use of Oral Analgesics and Pain Self-Efficacy Are Independent Predictors of the Quality of Life of Individuals with Rheumatoid Arthritis

“…Multiple previous studies have reported clinical and imaging remission in patients with RA, but few studies have focused on functional remission [4,30]. In the present study, we investigated important factors associated with QOL in patients with RA, and our findings suggest that the disease duration, PDQ, PSEQ, PCS, use of oral steroids, and use of oral analgesics play important roles in achieving functional remission.…”

“…RA affects approximately 0.5–1% of the population globally [ 3 ]. The combination of methotrexate and biological disease-modifying antirheumatic drugs (bDMARDs) has contributed to an increase in the number of patients who achieve clinical remission [ 4 ]. Disease activity in RA is often assessed using the disease activity score in 28 joints (DAS28) [ 5 ], which can further be combined with the C-reactive protein level (DAS28-CRP).…”

Management of inflammatory rheumatic conditions in the elderly

“…In a German longitudinal database, depression was present in 22% of the 1072 elderly RA patients (mean age 72 years), and dementia, cancer, osteoporosis, hypertension and diabetes were associated with a higher risk of developing depression [149]. Moreover, depression is associated with increased global mortality in RA [150], suicide death in RA and PsA [151], and reduced likelihood of joint remission in RA and PsA [152, 153]. However, anti-depressants are frequently associated with side effects and have inconstant benefits in pain management or functional status [154].…”

Features of inflammatory rheumatic diseases treatment in older people

“…В немецкой базе данных депрессия присутствовала у 22% из 1072 пожилых пациентов с РА (средний возраст 72 года), при этом риск развития депрессии был выше при наличии деменции, рака, остеопороза, гипертонии и диабета [151]. Более того, депрессия связана с повышением общей смертности при РА [152], смерти от суицида при РА и ПсА [153], а также снижением вероятности достижения ремиссии при РА и ПсА [154,155]. Однако при назначении антидепрессантов часто развиваются побочные эффекты, а их эффективность при коррекции болевого синдрома и функциональных нарушений не всегда предсказуема [156].…”