Comparison of the long-term outcome for patients with rheumatoid arthritis with persistent moderate disease activity or disease remission during the first year after diagnosis: data from the ESPOIR cohort

Combe, Bernard; Logeart, I.; Belkacemi, M.; Dadoun, Sabrina; Schaeverbeke, Thierry; Daurès, Jean‐Pierre; Dougados, Maxime

doi:10.1136/annrheumdis-2013-204178

Cited by 60 publications

(56 citation statements)

References 38 publications

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“…Despite these findings, the authors of this study emphasised the value of assessing all relevant joints in an individual patient, including the foot joints. We found that shorter remission times are associated with an increase in erosion scores, similar to others who have reported that active disease (32) and disease flares (33) lead to greater radiographic progression. Also, joint damage is preceded by increased disease activity (34) and therefore use of more stringent DA measures may allow earlier titration of targeted therapies in order to reduce radiographic progression.…”

Section: Discussionsupporting

confidence: 76%

Active Foot Synovitis in Patients With Rheumatoid Arthritis: Unstable Remission Status, Radiographic Progression, and Worse Functional Outcomes in Patients With Foot Synovitis in Apparent Remission

Wechalekar

Lester

Hill

et al. 2016

Arthritis Care & Research

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Objectives: To determine whether foot synovitis is associated with adverse radiographic and functional outcomes after 3 years in an inception rheumatoid arthritis (RA) cohort receiving treat-to-target combination DMARD therapy.Methods: Disease activity (DA) was assessed in early RA patients (n=266) using DAS28, clinical disease activity index (CDAI) and simplified disease activity index (SDAI).Radiographic outcomes were assessed with annual hand and feet radiographs and quality of life by SF-36. Prevalence of remission and foot synovitis was calculated using marginal binomial generalised estimating equations, transition between remission and non-remission states by a multi-state Markov model and changes in radiographic scores by a negative binomial mixed regression log-link model. Population matched SF-36 data were analysed by mixed-effects linear regression.Results: DA scores that omit foot joints were modest in their ability to capture foot synovitis.Despite relative stringency of SDAI and CDAI for remission, 25-36% of patients in remission had foot synovitis. In patients in remission, foot synovitis predicted transition from remission into relapse by up to 2-fold. Sustainability of remission markedly influenced progression of erosion scores (p=0.006). After adjusting for DA, foot synovitis was associated with worse SF-36 physical functioning (p=0.025).Conclusions: DA measures that omit foot joints capture foot synovitis poorly. When used to define remission, a substantial proportion have foot synovitis which predicts relapse and worse physical function. Foot synovitis influences sustainability of remission which in turn markedly influences radiographic progression. Regardless of remission status, persistent foot synovitis should prompt therapy escalation to improve long-term outcomes. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Rheumatoid arthritis (RA) is a systemic inflammatory disorder that can lead to progressive and irreversible joint damage. It is now well-established that intensive target-driven treatment with disease modifying anti-rheumatic drugs (DMARDs) produces substantial improvements in disease outcomes. These treatment strategies usually rely on a clinic-based composite disease activity (DA) measure and it follows that the ability of these measures to capture overall DA may influence disease outcomes.Various validated composite DA and remission measures have been utilised in published series. These include criteria that require a full joint count (e.g. the American College of Rheumatology (ACR) Boolean-based criteria) (1), and those employing abbreviated joint counts that omit assessm...

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Section: Discussionsupporting

confidence: 76%

Active Foot Synovitis in Patients With Rheumatoid Arthritis: Unstable Remission Status, Radiographic Progression, and Worse Functional Outcomes in Patients With Foot Synovitis in Apparent Remission

Wechalekar

Lester

Hill

et al. 2016

Arthritis Care & Research

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“…A systematic review by Carpenter (2016) indicated that RF, anti-CCP, along with increased markers of inflammation (ESR or CRP) were strongly associated with radiographic progression [44]. The ESPOIR study identified anti-CCP and baseline ESR as predictors of structural outcome [45]. Van der Heijde (1992) mentioned high disease activity measured as high ESR, CRP or DAS and a positive RF were all significantly associated with radiographic damage after 2 years of follow-up [46].…”

Section: Discussionmentioning

confidence: 99%

Radiographic progression in early rheumatoid arthritis patients following initial combination versus step-up treat-to-target therapy in daily clinical practice: results from the DREAM registry

et al. 2018

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Background: Early and intensive targeted treatment with disease modifying anti-rheumatic drugs (DMARDs) has been shown to lead to substantial reductions in disease activity and radiograph damage in patients with early rheumatoid arthritis (RA). The aim of this quasi-experimental study was to compare the first-year radiographic progression rates between a treat-to-target (T2 T) strategy with initial combination therapy (strategy II, started in 2012) versus an initial step-up monotherapy (strategy I, started in 2006).

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“…Nonetheless, many patients fail to achieve remission 1,2 , increasing the likelihood of functional deterioration 1,3 and additional clinic visits, laboratory tests, and treatment modifications.…”

mentioning

confidence: 99%

Adherence and Persistence with Methotrexate in Rheumatoid Arthritis: A Systematic Review

Curtis

Bykerk

Aassi³

et al. 2016

J Rheumatol

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Objective.Medication adherence in patients with rheumatoid arthritis (RA) is typically suboptimal. Nonadherence has been associated with symptom worsening and increased disability. We systematically reviewed published clinical studies to evaluate methotrexate (MTX) adherence and persistence, factors associated with MTX adherence and persistence, and the effect of MTX nonadherence on clinical outcomes in RA.Methods.MEDLINE and Embase were systematically searched (inception to February 2016) using relevant keywords. Observational or interventional clinical studies in patients with RA that specifically reported adherence to or persistence with MTX were included. Data were extracted using a predesigned, standardized template that included study design, patient demographics, and relevant outcomes. Main outcomes were MTX adherence and persistence rates in patients with RA treated with MTX and factors associated with MTX adherence and persistence.Results.Of 365 references screened, 31 articles met inclusion criteria and another 10 were identified from searching reference lists. Estimates of MTX adherence varied from study to study because of heterogeneity in patient populations, duration of followup, definitions of adherence, and methods of assessment. Rates of MTX persistence ranged from 50% to 94% at 1 year and 25% to 79% at 5 years. No clear trends were identified in factors that influence MTX adherence and persistence. Two studies suggested that MTX adherence was associated with superior clinical outcomes.Conclusion.MTX adherence and persistence are highly variable in patients with RA. Research is necessary to determine the effect of nonadherence on health outcomes and to identify independent predictors of nonadherence to inform evidence-based interventions.

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Comparison of the long-term outcome for patients with rheumatoid arthritis with persistent moderate disease activity or disease remission during the first year after diagnosis: data from the ESPOIR cohort

Cited by 60 publications

References 38 publications

Active Foot Synovitis in Patients With Rheumatoid Arthritis: Unstable Remission Status, Radiographic Progression, and Worse Functional Outcomes in Patients With Foot Synovitis in Apparent Remission

Active Foot Synovitis in Patients With Rheumatoid Arthritis: Unstable Remission Status, Radiographic Progression, and Worse Functional Outcomes in Patients With Foot Synovitis in Apparent Remission

Radiographic progression in early rheumatoid arthritis patients following initial combination versus step-up treat-to-target therapy in daily clinical practice: results from the DREAM registry

Adherence and Persistence with Methotrexate in Rheumatoid Arthritis: A Systematic Review

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