PARIS — Factors that predict which patients with rheumatoid arthritis will achieve and maintain stable remission following treatment with traditional disease-modifying drugs include low body mass index, low erythrocyte sedimentation rate levels, and absence of anti-cyclic citrullinated peptide antibody at baseline.
“In light of the fact that remission is increasingly becoming an attainable goal in rheumatoid arthritis treatment, it would be useful to be able to predict which patients are likely to achieve remission in the long run, and so to be able to avoid overly aggressive treatment and the associated side effects,” Dr. Diane van der Woude said at the annual European Congress of Rheumatology.
Although some factors have been identified that predict the achievement of very low disease activity with biologic agents, little is known about the characteristics and predictive factors of patients who are treated with less aggressive, conventional disease-modifying antirheumatic drugs (DMARDs), said Dr. van der Woude of the department of rheumatology at Leiden (the Netherlands) University Medical Center.
Dr. van der Woude and colleagues analyzed clinical, laboratory, and genetic data from patients enrolled in an inception cohort at the Leiden Early Arthritis Clinic between 1993 and 2003.
Among more than 1,900 patients referred to the clinic, 454 were diagnosed with RA and treated with chloroquine, sulfasalazine, or methotrexate, she said.
Sustained remission, defined as the absence of synovitis for longer than 1 year without the use of DMARDs, was achieved by 69 of these patients (15%) with an average follow-up of 8 years.
Six patients who had originally been discharged from the clinic because of remission experienced a recurrence of synovitis and were excluded from the remission group.
Univariate analysis revealed that the following factors were significantly associated with less likelihood of achieving DMARD-free remission: positive family history (hazard ratio 0.56); high body mass index (HR 0.90); long duration of symptoms at presentation (HR 0.93); smoking (HR 0.55); and the presence of IgM rheumatoid factor (HR 0.17), anti-cyclic citrullinated peptide (CCP) antibodies (HR 0.09), and shared epitope alleles (HR 0.47).
Multivariate analysis identified older age, low body mass index, low erythrocyte sedimentation rate, short duration of symptoms, nonsmoking status, and the absence of anti-CCP antibodies as being independent predictors for achieving DMARD-free remission, she said.
These findings demonstrate that “several clinical factors that are routinely assessed in clinical practice are robust predictors of achieving stable remission,” Dr. van der Woude said.