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.


Age, Sex, RF Antibodies, Baseline HAQ and DAS28 ScoreBut Not the Type of Initial TreatmentAre Predictive of Clinical Remission at 1 Year in Early Inflammatory Arthritis.

Kuriya9,  Bindee, Haraoui4,  Boulos, Boire2,  Gilles, Hitchon7,  Carol A., Pope6,  Janet E., Thorne5,  J. Carter, Ferland3,  Diane S.

Brigham and Women's Hospital, Toronto, ON, Canada
CHUS-Sherbrooke University, Sherbrooke, QC, Canada
Hospital Maisonneuve Rosemount, LaSalle, QC, Canada
Institut de Rhumatologie, Montreal, QC, Canada
Southlake Regional Health Care, Newmarket, ON, Canada
St Joseph Health Care London, London, ON, Canada
University of Manitoba, Winnipeg, MB, Canada
University of Toronto, Toronto, ON, Canada
University of Toronto, Brookline, MA

Background:

Aggressive DMARD therapy is more effective when given early in the disease course and the goal of treatment is remission. Factors associated with remission have been inconsistently reported in studies of early inflammatory arthritis (EIA). In Canada, access to biologics is reserved for those who have failed >= 2 DMARDs. Identifying those who will achieve remission can facilitate decisions to prevent over/under-treatment with limited resources. Our aim was to identify baseline and early treatment predictors of DAS28 remission at 1 year.

Methods:

As of November 2009, 893 subjects were recruited to the Canadian ArThritis CoHort (CATCH). Patients are >16 years old, have symptoms between 6 weeks–12 months, have >= 2 swollen joints or 1 swollen MCP or PIP joint and >=1 of: positive RF, anti-CCP, morning stiffness, response to NSAID or painful MTP squeeze test. Patients are assessed every 3 months and therapy is adjusted to minimize disease activity. Baseline demographic and clinical characteristics were analyzed via logistic regression.

Results:

363 subjects had >= 1 year of follow-up. Over this time, 288 (79%) patients met criteria for RA and 75 (21%) remained undifferentiated or fulfilled other diagnoses. Overall, 147 (41%) achieved DAS28 remission at 1 year. In univariate analyses, patients who experienced remission were younger, male, had lower HAQ scores, lower ESR and lower disease activity at baseline. Physical examination findings and radiographic erosions did not discriminate between the two groups. The presence of RF antibodies was less frequent among those who experienced remission but anti-CCP antibodies did not differ. The use of DMARDs early in the disease course was variable; methotrexate monotherapy was used less, while combination DMARD therapy was used more frequently in patients achieving remission. No patients were commenced on biologics during the first 3 months. After adjusting for significant univariate predictors (p<0.10), the multivariate model revealed 5 factors to be associated with remission: age, sex, RF, HAQ score and DAS28 score (Table, p<0.05).

Conclusion:

Clinical remission was achievable in 41% of EIA patients. Predictors that favorably impacted this response included younger age, male sex, absent RF, low HAQ, and low disease activity at baseline. While sustained treatment with DMARDs has favorable long-term outcomes, DMARD use during the first 3 months alone or in combination did not accurately predict remission at 1 year.

Table. Multivariate analysis of baseline predictors for DAS28 remission at 1 year.

CharacteristicOR (95% CI)p-value
Age*, years0.98 (0.9–1.01)0.03
Female sex0.44 (0.25–0.78)0.01
RF positive0.78 (0.47–0.99)0.04
HAQ score*0.66 (0.44–0.98)0.04
DAS28 score0.06 (0.44–0.98)0.03
ESR*, mm/hr0.99 (0.98–1.01)0.77
MTX monotherapy0.59 (0.29–1.21)0.15
Combination DMARD therapy1.52 (0.84–2.75)0.16
*Treated as continuous variables

To cite this abstract, please use the following information:
Kuriya, Bindee, Haraoui, Boulos, Boire, Gilles, Hitchon, Carol A., Pope, Janet E., Thorne, J. Carter, et al; Age, Sex, RF Antibodies, Baseline HAQ and DAS28 ScoreBut Not the Type of Initial TreatmentAre Predictive of Clinical Remission at 1 Year in Early Inflammatory Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1737
DOI: 10.1002/art.29502

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