Remission in early rheumatoid arthritis: predicting treatment response.

Abstract

OBJECTIVE:

Optimizing therapeutic strategies to induce remission requires an understanding of the initial features predicting remission. Currently no suitable model exists. We aim to develop a remission score using predictors of remission in early rheumatoid arthritis (RA).

METHODS:

We used a dataset from a UK randomized controlled trial that evaluated intensive treatment with conventional combination therapy, to develop a predictive model for 24-month remission. We studied 378 patients in the trial who received 24 months' treatment. Our model was validated using data from a UK observational cohort (Early RA Network, ERAN). A group of 194 patients was followed for 24 months. Remission was defined as 28-joint Disease Activity Score < 2.6. Logistic regression models were used to estimate the associations between remission and potential baseline predictors.

RESULTS:

Multivariate logistic regression analyses showed age, sex, and tender joint count (TJC) were independently associated with 24-month remission. The multivariate remission score developed using the trial data correctly classified 80% of patients. These findings were replicated using ERAN. The remission score has high specificity (98%) but low sensitivity (13%). Combining data from the trial and ERAN, we also developed a simplified remission score that showed that younger men with a TJC of 5 or lower were most likely to achieve 24-month remission. Remission was least likely in older women with high TJC. Rheumatoid factor, rheumatoid nodules, and radiographic damage did not predict remission.

CONCLUSION:

Remission can be predicted using a score based on age, sex, and TJC. The score is relevant in clinical trial and routine practice settings.

• Authors: Margaret H Y Ma, Fowzia Ibrahim, David Walker, Andrew Hassell, Ernest H Choy, Patrick D W Kiely, Richard Williams, David A Walsh, Adam Young, David L Scott
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 39 Issue 3 Pg. 470-5 (Mar 2012) ISSN: 0315-162X [Print] Canada
• PMID: 22247360 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antirheumatic Agents
• Methotrexate

Topics

• Age Factors
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (drug therapy, physiopathology)
• Disability Evaluation
• Drug Therapy, Combination
• Female
• Humans
• Joints (physiopathology)
• Logistic Models
• Male
• Methotrexate (therapeutic use)
• Middle Aged
• Predictive Value of Tests
• Remission Induction
• Sensitivity and Specificity
• Sex Factors
• Treatment Outcome
• United Kingdom