Predictors and outcomes of sustained, intermittent or never achieving remission in patients with recent onset inflammatory polyarthritis: results from the Norfolk Arthritis Register

Abstract

Objectives. Early remission is the current treatment strategy for patients with inflammatory polyarthritis (IP) and RA. Our objective was to identify baseline factors associated with achieving remission: sustained (SR), intermittent (IR) or never (NR) over a 5-year period in patients with early IP.Methods. Clinical and demographic data of patients with IP recruited to the Norfolk Arthritis Register (NOAR) were obtained at baseline and years 1, 2, 3 and 5. Remission was defined as no tender or swollen joints (out of 51). Patients were classified as NR or PR, respectively, if they were in remission at: no assessment or ⩾3 consecutive assessments after baseline, and IR otherwise. Ordinal regression and a random effects model, respectively, were used to examine the association between baseline factors, remission group and HAQ scores over time.Results. A total of 868 patients (66% female) were included. Of these, 54%, 34% and 12% achieved NR, IR and SR, respectively. In multivariate analysis, female sex (odds ratio, OR 0.47, 95% CI: 0.35, 0.63), higher tender joint count (OR = 0.94, 95% CI: 0.93, 0.96), higher HAQ (OR = 0.59, 95% CI: 0.48, 0.74), being obese (OR = 0.70, 95% CI: 0.50, 0.99), hypertensive (OR = 0.67, 95% CI: 0.50, 0.90) or depressed (OR = 0.74, 95% CI: 0.55, 1.00) at baseline were independent predictors of being in a lower remission group. IR and SR were associated with lower HAQ scores over time and lower DAS28 at year 5.Conclusion. Women with higher tender joint count and disability at baseline, depression, obesity and hypertension were less likely to achieve remission. This information could help when stratifying patients for more aggressive therapy.

Rheumatoid arthritis patients on persistent moderate disease activity on biologics have adverse 5-years outcome compared to persistent low-remission status and represent a heterogeneous group.

“…Interestingly, residual disease activity was the major contributor to HAQ increase over time (Table 2). These data are comparable to those from early RA cohorts on csDMARDs assessing the cumulative effect of disease activity on RA-related outcomes (9,10,12). Although one might argue that this nding is an expected one, we considered clinically important and novel to focus for the rst time on patients treated with bDMARDs, which might exert differential immunomodulatory effects as compared to csDMARDs.…”

Improving recognition of anxiety and depression in rheumatoid arthritis: a qualitative study in a community clinic

“…1 In common with other LTCs, 2 RA is associated with an increased prevalence of both depression and anxiety (estimated to affect 39% and 20% respectively). 3,4 Coexistent mood disorders in RA are associated with reduced remission rates, 5 increased morbidity and mortality, 6 and raised healthcare costs. 2 Despite this, studies suggest that anxiety and depression are under-recognised and under-treated.…”

Unmet need in rheumatology: reports from the Targeted Therapies meeting 2018

“…The RA group (table 1) reiterated the progress made to date with treatment of RA, including the strategy of ‘treat to target’ with rapid dose escalation of methotrexate followed by addition of either biologic disease-modifying antirheumatic drugs (DMARDs) or targeted small molecules. However, the committee also recognised that a significant proportion of patients continue to have moderate to high disease activity despite these therapeutic approaches, and the group highlighted the need to further define ‘treatment-resistant disease’ 7. These patients should be the priority for study with new molecules, as they remain the most difficult to treat.…”