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.
Sustained Remission in Early RA: Results from SONORA Study.
Bombardier3, Claire, Akhavan2, Pooneh, Chen1, Maggie, Li1, Xiuying
Remission constitutes the best achievable state in patients with rheumatoid arthritis (RA). Current measures of Disease Activity - such as the DAS28 - define the patient's remission status at a given point in time. While, for the patient, sustained remission over time is the ultimate goal. The purpose of this study is to assess the frequency and predictors of sustained remission in a large cohort of early RA patients in regular clinical practice.
A total of 994 patients diagnosed as early RA (symptoms >=3 and <=12 months) by a board-certified rheumatologist across North America were recruited in this study. We analyzed remission and sustained remission in 851 patients who had two-year complete follow up information. Remission was defined as less than 2.6 for DAS28 and sustained remission was defined as consecutive remission at year 1 and year 2. Univariate logistic regressions were used to explore the predictors for sustained remission and multivariate logistic regression were used to estimate the remission probabilities controlling for significant factors.
The mean age of patients was 53 years (SD, 14.8), with 72% female and 90% Caucasian. The mean RA symptom duration was 170 days (180), 61% were seropositive for rheumatoid factor and 43% anti-CCP positive (>20 unit/ml) at baseline. Seventy-four percent of patients had received DMARDs at baseline compared to 90% at year 1 and, 87% at 2. Two percent of the subjects were on Biologics at baseline compared to 15%, 23% at year 1 and 2. Remissions at any one of the two visits were seen in 238 (28%) patients. Among them, 68 (8%) patients achieved sustained remission. The univariate logistic regression showed that low baseline DAS28 score, HAQ score, disease duration and CRP are significant predictors for sustained remission. The multivariate logistic regression showed that HAQ is no longer significant when other factors (low baseline DAS28, low CRP and short disease duration) are in the model. The final model therefore excludes HAQ as a predictor.
Low sustained remission rates were observed in this early RA cohort recruited before the wide use of biologics. The multivariate model predicts the probability of sustained remission using easily accessible clinical and laboratory variables. These identified factors can help guide rheumatologists in making treatment decisions for early RA patients.
|Odds ratio||95% CI||P-value|
|Baseline DAS28||0.660||(0.536, 0.813)||<0.0001|
|Disease duration (in months)||0.878||(0.796, 0.968)||0.0091|
To cite this abstract, please use the following information:
Bombardier, Claire, Akhavan, Pooneh, Chen, Maggie, Li, Xiuying; Sustained Remission in Early RA: Results from SONORA Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :336