In patients with early rheumatoid arthritis (RA), suboptimal psychosocial well-being and negative illness perceptions predict a lower probability of achieving and maintaining remission, despite the use of intensive target-to-treat therapy, according to results of a study published in Arthritis Care & Research (Hoboken).

The researchers sought to evaluate the effect of psychosocial characteristics on disease activity and remission among patients with early RA.

In a post-hoc analysis, the researchers assessed data from the multicenter, prospective, 2-year, randomized controlled Care in Early RA (CareRA; EudraCT: 2008-007225-39) trial. Sustained remission was defined as continued Disease Activity Score in 28 joints (DAS28) C-reactive protein (CRP) of less than 2.6 from weeks 16 to 104. All participants completed the Short-Form 36 (SF-36), the Revised Illness Perception Questionnaire, and the Utrecht Coping List. All psychosocial variables were examined at baseline and at week 16, as predictors of sustained remission.


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Subgroups of participants who were in remission at week 16 were identified using Latent Profile Analysis, according to the psychosocial indicators. Time to initial loss-of-remission was then compared between the groups. Directionality of associations between the psychosocial indicators and DAS28-CRP was also evaluated.

A total of 379 patients were enrolled from 13 Belgian rheumatology centers. Eligible patients were diagnosed with RA less than 1 year previously and were disease-modifying antirheumatic drug (DMARD)-naive at study onset.

Results of the study showed that among the 287 participants with sustained DAS28-CRP remission at week 16 of the study, 2 subgroups were identified: a low psychosocial burden group, which included 80% of the participants, and a high psychosocial burden group, which included 20% of the participants.

Among patients in DAS28-CRP remission at week 16, those in the low psychosocial burden group had a significantly longer time to first loss-of-remission compared with those in the high psychosocial burden group (hazard ratio [HR], 0.51; 95% CI, 0.35-0.73; P <.001). Similar results were reported with regard to Clinical Disease Activity Index for Rheumatoid Arthritis remission (HR, 0.54; 95% CI, 0.32-0.89; P =.016).

According to cross-lagged panel models, temporal relationships between psychosocial well-being and DAS28-CRP were shown to be complex, bidirectional, and disease-phase-dependent.

The researchers noted that the findings from the current study demonstrated that illness perceptions among the early RA cohort appeared to become more clinically relevant with time. In fact, 1 in 5 patients exhibited worse psychosocial outcomes despite early disease remission, with these individuals likely to lose remission sooner. Suboptimal well-being despite disease remission is common among patients with RA and warrants special attention from clinicians.

They concluded, “…future research should aim to develop tools to help clinicians to timely identify patients with such unmet needs in clinical practice.”

Reference

Doumen M, De Cock D, Pazmino S, et al. Psychosocial burden predicts sustained remission in early rheumatoid arthritis: unraveling the complex interplay of wellbeing and disease activity. Arthritis Care Res (Hoboken). Published online December 20, 2021.
doi:10.1002/acr.24847