Predictors of Persistent Disease Activity During First Year of RA Treatment

The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

CHICAGO — Among patients with early rheumatoid arthritis (RA), obesity in women and current smoking in men are the strongest predictors of not attaining remission in the first 12 months, followed by not using methotrexate (MTX), higher baseline inflammation, and longer symptom duration, according to the results of a large nationwide Canadian cohort study presented at the ACR/ARHP 2018 Annual Meeting, held October 19-24, in Chicago, Illinois.

The investigators sought to identify and compare predictors of persistent disease activity in the first year of RA treatment among men and women. Adult patients from the Canadian Early Arthritis Cohort (2007-2016) who had active disease at baseline were evaluated. Predictors of failure to achieve remission (Disease Activity Score in 28 joints, <2.6) by 12 months were assessed.

A total of 1628 adults with RA were evaluated. The mean participant age was 55±15 years, and 72% of the patients were women. The mean number of comorbidities was 2±2, and mean symptom duration was 6±3 months. Most of the participants initially received treatment with conventional synthetic disease-modifying antirheumatic drugs, and approximately 75% of patients were initially treated with MTX.

Overall, 44% of women and 36% of men did not attain disease remission by 12 months. Among women, obesity more than doubled the odds of not achieving remission (odds ratio [OR], 2.06; 95% CI, 1.49-2.83). Other key predictors included minority status (OR, 1.46; 95% CI, 1.07-2.00), lower education level (OR, 1.41; 95% CI, 1.09-1.82), higher tender joint counts at baseline (OR, 1.03; 95% CI, 1.01-1.06), and higher fatigue scores at baseline (OR, 1.05; 95% CI, 1.00-1.09). Among men, current smoking was linked to a 3.5 greater likelihood of not achieving remission in the first year (OR, 3.45; 95% CI, 2.06-5.77), with other predictors including older age (OR, 1.48; 95% CI, 1.22-1.79) and higher levels of pain (OR, 1.11; 95% CI, 1.03-1.20).

Lack of use of MTX increased the odds of not attaining remission in women by 28% (OR, 0.72; 95% CI, 0.54-0.95), and in men by 45% (OR, 0.55; 95% CI, 0.33-0.90). Longer symptom duration and higher erythrocyte sedimentation rates were associated with not achieving remission among both women and men.

The investigators concluded that weight reduction among women and smoking cessation among men, along with optimizing the use of MTX, may assist with the rapid reduction of inflammation in early RA.

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Reference

Bartlett SJ, Schieir O, Valois MF, et al. Lifestyle and MTX use are the strongest predictors of not achieving remission in the first year of rheumatoid arthritis: results from the Canadian Early Arthritis Cohort (CATCH). Presented at: ACR/ARHP 2018 Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 600.

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