Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
A State of Sustained DAS Remission Is Determined by Time to Achieve Remission
Schipper1, Lydia G., Fransen1, Jaap, Den Broeder2, Alfons A., van Riel1, Piet L.C.M.
Reaching remission is an important goal in current treatment of early RA. However, the number of patients who achieve and sustain remission in daily practice is still small, and determinants for achieving sustained remission are largely unknown. Therefore, this study analysed the association between time to achieve first remission and sustainability of remission in a cohort of early RA patients, treated according to daily practice.
For this study, three-year follow-up data were used from the Nijmegen Inception RA Cohort of 1985 to 2005. Patients were included upon diagnosis (ACR criteria), were systematically evaluated at three-monthly visits and were treated according to daily practice routine. Remission was defined according to the Disease Activity Score (DAS) < 1.6 and according to the ACR remission criteria. Six months duration of remission or more (three consecutive visits) was defined as sustained remission. Univariate predictors for achieving and sustaining remission were identified using Cox-regression and logistic regression, respectively. The relation between time to achieve first remission and sustained remission was analyzed using longitudinal binary regression, including correction for potential confounders.
There were 753 patients included, with a mean age of 67 years, 63% was female, 77% had a positive rheumatoid factor, and mean baseline DAS was 4.0. Within three years, 398 (53%) patients achieved remission at least one visit. The median time to remission was 12 months. Male patients and younger patients reached remission significantly sooner than female patients or older patients (P<0.01). Also, patients with a lower baseline DAS or HAQ achieved remission more rapidly than those with a higher value at baseline (P<0.0001). There were 142 (36%) patients who experienced sustained remission (mean 78 weeks). Sustained remission was determined by a shorter time to achieve first remission (P<0.0001), besides low DAS and HAQ at baseline (P<0.05). There was a significant relation between time to achieve remission and sustained remission (odds ratio 1.11, 95% CI 1.101.12, P<0.0001, adjusted for baseline DAS), which was constant over the whole period of 1985 to 2005. Results with the ACR remission criteria were similar.
Remission was more often sustained in patients who achieved their first remission rapidly. These results support the use of aggressive treatment to aim for early remission in RA.
To cite this abstract, please use the following information:
Schipper, Lydia G., Fransen, Jaap, Den Broeder, Alfons A., van Riel, Piet L.C.M.; A State of Sustained DAS Remission Is Determined by Time to Achieve Remission [abstract]. Arthritis Rheum 2009;60 Suppl 10 :975