Several distinct disease trajectory subpopulations were identified among patients with rheumatoid arthritis (RA), according to study results published in Therapeutic Advances in Musculoskeletal Disease.

Patients with early untreated seropositive RA from 28 centers across the UK were enrolled in the study. Researchers collected multiple clinical and laboratory measures every 3 months for up to 18 months. The 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and Simplified Disease Activity Index (SDAI) were used to measure disease activity. Clinical predictors of 6-month remission were examined and disease course characterized by logistic regression and latent class mixed models, respectively.

Overall, 267 patients were eligible for the trial. According to DAS29-CRP and SDAI scores, patients had moderate to severe disease at baseline. A total of 245 patients were followed-up with to or after their 6-month assessment visit; 239 attended the 6-month visit. Mean DAS28-CRP and SDAI at 6 months were 3.04±1.25 and 11.37±10.71, respectively. Based on the SDAI definition, 57 patients (24.3%) attained remission at 6 months.


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Factors predictive of 6-month remission were lower baseline Health Assessment Questionnaire (HAQ; P =.013) and SDAI (P =.011), baseline prescribing of methotrexate with a second disease-modifying antirheumatic drug, and alcohol intake.

There were 3 distinct SDAI disease trajectory subpopulations identified: an inadequate responder group (6.5%), higher baseline activity responder group (22.4%), and lower baseline activity responder group (71.1%). These groups were distinguished by baseline HAQ and the Short Form-36 Health Survey – Mental Component Score. Several baseline clinical predictors correlated with disease severity within subpopulations and beneficial effects of alcohol intake were found across subpopulations.

The generalizability of the results was limited by the decision to enroll an inception cohort with low levels of comorbidities.

Researchers concluded, “Our data further highlight RA heterogeneity (ie, trajectory classes) not explainable by clinical factors and indicate the possible use of biomarkers collected at baseline and early follow-up to help patient management and better targeting of existing and novel therapies.”

Reference

RA-MAP Consortium. Characterization of disease course and remission in early seropositive rheumatoid arthritis: results from the TACERA longitudinal cohort study. Ther Adv Musculoskelet Dis. 2021;13:1-17. doi:10.1177/1759720X211043977