Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Disease Activity in Patients with Early Rheumatoid Arthritis Receiving Stable Conventional DMARDs Significantly Influences the Timing of Achieving a Low Disease State and Remission at 3 Versus 6 Months.

Akhavan3,  Pooneh, Bykerk3,  Vivian P., Sun4,  Ye, Hochman7,  J., Pope10,  Janet E., Pope10,  Janet E., Hitchon11,  Carol A.

Canada
St Joseph Health Care London, London, ON, Canada
University of Manitoba, Winnipeg, MB, Canada
University of Toronto, Toronto, ON, Canada
Institut de Rhumatologie, Montreal, QC, Canada
Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
Mt Sinai Hosp, Toronto, ON, Canada
Rheumatology, Hopital Maisonneuve, LaSalle, QC, Canada
Rheumatology, University of Toronto
Sherbrooke University, Sherbrooke, QC, Canada
Southlake Regional Health Care, Newmarket, ON, Canada

Purpose:

To date timing of treatment outcomes and responses have been evaluated mainly in retrospective studies of clinical trials in patients with high disease activity. Studies in real world patient populations with more moderate disease are sparse. We were interested in evaluating these outcomes in such a setting. The primary objective of this study was to evaluate the influence of disease activity on the timing to achieve Low Disease Activity State (LDAS) and remission (REM) in early rheumatoid arthritis (ERA) patients receiving stable treatment. We also explored the effect of baseline disease activity on response to treatment.

Methods:

Patients with early RA in the Canadian Early Arthritis Cohort (CATCH), were evaluated. Patients who were receiving stable DMARDS for 6 months (with no dose adjustments after one month of initiating therapy and not receiving oral or parenteral steroids) were included. The majority of patients were receiving methotrexate ± sulphasalazine ± hydroxychloroquine. Patients with baseline moderate disease activity (MDA) (DAS28 >= 3.2 –5.1) (n= 38) versus high disease activity (HDA) (DAS 28 > 5.1) (n= 61) who had not achieved LDAS or REM at 3 months were evaluated for the proportion achieving LDAS or REM at 6 months. DAS 28 responses for these patients was compared at these two time points. We defined a poor therapeutic response by a DDAS 28 < 0.6 and good response by a DDAS < 1.2.

Results:

108 patients were evaluated with mean age of 50 years and mean disease duration of 6.3 ± 3.0 (mead ± sd) months at baseline. Rheumatoid factor was positive in 60% of patients. The majority of MDA patients achieved LDAS or REM by 3 months with a slightly greater proportion requiring 6 mo to achieve adequate clinical response. At 3 mo 58% of MDA patients achieved LDAS versus 63% at 6 months. Of 16 patients not in LDAS, 31% achieved it by 6 months. At 3 months 47% of MDA patients achieved REM versus 50% at 6 months. Of 20 patients not in REM at 3months 25% achieved it by 6 months. In patients with HDA a substantial number of patients required 6 months to achieve LDAS or REM. In these HDA patients 34% achieved LDAS at 3 months versus 62% at 6 months. Of 40 patients not achieving LDAS at 3 months 48% achieved it by 6 months while of 51 patients not achieving REM at 3 months 43% achieved it by 6 months. Of interest, almost all HDA patients achieved a DDAS > 0.6 (93%) or DDAS > 1.2 (84%) at 3 months. In contrast 37% of MDA patients failed to achieve a D DAS of 0.6 and 53% a change of 1.2 at 3 months. Of MDA patients with a D DAS of < 0.6 at 3 months, 36% achieved LDAS and 29% achieved REM at 6 months. Similar results were observed with a D DAS < 1.2 at 3months.

Conclusion:

Baseline disease activity has a significant effect on timing to achieve an adequate clinical response. In HDA patients particularly consideration should be given to continuing therapy for at least 6 months if LDAS or REM is not achieved at 3 months.

To cite this abstract, please use the following information:
Akhavan, Pooneh, Bykerk, Vivian P., Sun, Ye, Hochman, J., Pope, Janet E., Pope, Janet E., et al; Disease Activity in Patients with Early Rheumatoid Arthritis Receiving Stable Conventional DMARDs Significantly Influences the Timing of Achieving a Low Disease State and Remission at 3 Versus 6 Months. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :306
DOI: 10.1002/art.28075

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