Date Published: April 19, 2019
Publisher: Public Library of Science
Author(s): Yoon-Kyoung Sung, Kazuki Yoshida, Femke H. M. Prince, Michelle L. Frits, Soo-Kyung Cho, Jung-Yoon Choe, Hye-Soon Lee, Jisoo Lee, Shin-Seok Lee, Dae-Hyun Yoo, Simon M. Helfgott, Nancy A. Shadick, Michael E. Weinblatt, Daniel H. Solomon, Sang-Cheol Bae, Dominique Heymann.
Remission is a key goal in managing rheumatoid arthritis (RA), with sustained remission as the preferred sequelae of short-term remission. However little is known about the predictors of sustained remission for patients reaching remission. Using two independent cohorts, we aimed to evaluate the prevalence and predictors for sustained remission.
The study cohort consisted of subjects with RA from the Brigham and Women’s Hospital Rheumatoid Arthritis Sequential Study (BRASS) and the Korean Observational Study Network for Arthritis (KORONA). We analyzed subjects who reached remission in 2009 with follow up data for two consecutive years. Remission was defined by the Disease Activity Score 28- (DAS28-CRP) of less than 2.6. Sustained remission was defined as three consecutive annual visits in remission. Predictors for sustained remission were identified by multivariate logistic regression analysis.
A total of 465 subjects were in remission in 2009. Sustained remission was achieved by 53 of 92 (57.5%) in BRASS and by 198 of 373 (53.1%) in KORONA. In multivariate analyses, baseline predictors of sustained remission were: disease duration less than 5 years [odds ratio (OR) 1.96, 95% confidence interval (95% CI) 1.08–3.58], Modified Health Assessment Questionnaire (MHAQ) score of 0 (OR 1.80, 95% CI 1.18–2.74), and non-use of oral glucocorticoid (OR 1.58, 95% CI 1.01–2.47).
More than half of RA subjects in remission in 2009 remained in remission through 2011. Short disease duration, no disability, and non-use of oral glucocorticoid at baseline were associated with sustained remission.
Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that affects synovial joints. The pathology of the disease process often leads to serious functional disability and chronic pain caused by destruction of the joint . Previous studies have reported that intensive management of RA improves radiographic disease progression, physical function, and quality of life [2–5]. Hence, remission is a key goal that is now achievable with advances in available therapies [6, 7]. Since disease progression is more likely to occur in patients achieving short-term remission than in those achieving sustained remission, which is more likely to improve patient outcomes . However, a small number of patients can achieve sustained remission in clinical practice , and disease flare and recurrence can happen unexpectedly, even if patients achieve remission . Therefore, identifying the predictors of sustained remission in clinical practice is important for physicians and patients to plan treatments.
The present study investigated the prevalence and predictors for sustained remission in established RA. The long-term follow-up data from the BRASS and KORONA cohorts revealed that sustained remission occurred during 2009 through 2011 in 54.0% of patients with remission in 2009. Disease duration less than 5 years, MHAQ of 0, and non-use of oral glucocorticoid were predictors of sustained remission in multivariate analysis.
Our study demonstrated that the 2 year sustained remission rate of subjects in remission in 2009 was 54%. We identified several predictors of sustained remission that might be useful in stratifying patients with established RA in typical practice. Such variables may help identify patients who can attempt discontinuation of DMARDs or whose therapy should be closely monitored since they are a great risk of flares after reaching remission.