Prognostic factors for remission in early rheumatoid arthritis: a multiparameter prospective study

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.

Response to traditional disease-modifying anti-rheumatic drugs in indigent South Africans with early rheumatoid arthritis

“…Similar findings have been reported previously in early and established RA where lower joint counts and less functional disability were good prognostic markers for long term low disease activity or remission 18,19 . We also observed that higher baseline Hb level, and a lesser extent lower platelet count, was predictive of a better outcome at 12 months.…”

A clinical pharmacogenetic model to predict the efficacy of methotrexate monotherapy in recent‐onset rheumatoid arthritis

“…The DAS has proven to be a prognostic marker for the prevention of joint and cartilage destruction (1,15). Although our model has not shown its value to predict prolonged and sustained suppression of disease activity, other studies have already demonstrated that early suppression of disease activity is associated with better long-term outcomes (2,15).…”

“…These criteria differ slightly from the original European League Against Rheumatism criteria, because DAS improvement from baseline is not incorporated, but are in concordance with the BeSt study design (5,55). The DAS has proven to be a prognostic marker for the prevention of joint and cartilage destruction (1,15). Although our model has not shown its value to predict prolonged and sustained suppression of disease activity, other studies have already demonstrated that early suppression of disease activity is associated with better long-term outcomes (2,15).…”

“…Baseline variables possibly influencing the patient's disease state and MTX response were selected based on the literature (10)(11)(12)(13)(14)(15)(16)(17)(18)20,23,27,28). The following factors were iden-tified: sex; rheumatoid factor (RF) status; age; duration of joint symptoms; alcohol consumption; smoking; body mass index; menopausal status; hormone supplementation; scores for physician's assessment of disease activity, pain, patient's assessment of disease activity, patient's assessment of global health, and morning stiffness on a 0-100-point VAS; Health Assessment Questionnaire (HAQ) score (29); ESR; C-reactive protein level; DAS; SJC; RAI; kidney function (defined as creatinine clearance); anti-cyclic citrullinated peptide (anti-CCP) status; NSAID use; and the existence of comorbidity based on drug use (other than RA disease-related drugs).…”

“…Previously, the influences of demographic, clinical, immunologic, and genetic factors on the state of disease in patients with RA have been studied (10)(11)(12)(13)(14)(15)(16)(17)(18). Specifically, polymorphisms in genes coding for methylenetetrahydrofolate reductase (MTHFR), adenosine monophosphate deaminase (AMPD1), aminoimidazole carboxamide ribonucleotide transformylase (ATIC), serine hydroxymethyltransferase 1 (SHMT1), and inosine triphosphate pyrophosphatase (ITPA) demonstrate association with the MTX response (19)(20)(21)(22).…”