BackgroundRA treatment involves starting early with a DMARD. MTX achieves good sustained response in 30–40% of patients (pts). When MTX response is insufficient add other DMARD by achieve RA remission. Different factors may affect the response to MTXObjectivesTo analyze the clinical and demographic characteristics related to response to MTX in RA pts DMARD-naïveMethodsWe enrolled between 2011 and 2015, pts>18years RA diagnosed (ACR 1987 criteria), treated firs with MTX monotherapy (MTXm). A case-control study (MTXm persistence with CRP-DAS28<3.2 and suspension of MTXm by ineffectiveness or toxicity, respectively) was performed. We collected information that can influence the response to MTXm by medical records review and patient survey. A descriptive and analitical study with SPSS statistics 21 was performedResultsWe included 222 pts (70 men and 152 women). The characteristics of cases (123) and controls (99) are shown in the table. The causes of MTXm suspension were remission (7), intolerance/toxicity (19) and inefficiency (79). MTX was discontinued in 40 (18.2%) pts, 28 (12.7%) of them by intolerance/toxicity. Of 123 (55.4%) responders, 71 (32.0%) were CRP-DAS28<2.6. MTXm response was associated with age at onset ≥60 years (χ2 18.47, p<0.01, OR 3.67), rheumatoid factor (RF) <100 IU (χ2 10.92, p<0.01, OR 3.16) and current smoking (χ2 12.71, p<0.01, OR 2.95). Tobacco was associated with RF+ (χ2 8.9 p<0.01 OR 2.59 (1.37; 4.89) and ACPA+ (χ2 4.49 p<0.05 OR 1.88 (1.04, 3.38). We found no association with gender, education, job, coffee, tea or alcoho drinks, comorbidities, cardiovascular risk, possitivity ACPA or FR, RA presentation, treatment delay, or corticosteroid use. We found no correlation between age of RA-onset and RF or ACPA levels and MTXm duration. MTXm persistence at 5 years was 59% pts and their median survival was 93 months (77.14 to 108.8). We only found significant differences in favor of non-smokers and RF<100Table 1.Clinical and sociodemographics characterisitics of RA patientsCharacteristicsRespondersNonrespondersStatistic Significancy n=125n=99 Age at onset (y) (mean, SD)53.48 (13.0)46.65 (11.5)t=4.08 p=00006Female n (%)80 (65.0)72 (72.7)nsCurrent Smokers n (%)23 (18.7)40 (40.4)χ2 12.7 (p<0,01)OR 2.95 (1.6, 5.4)Alcohol consumers n (%)35 (28.5)28 (28.3)nsComorbidity n (%)92 (74.8)61 (61.6)χ2 4.45 (p<0.05)OR 1.21 (1.0, 1.5)CV risk factors n (%)92 (74.8)81 (81.8)nsPolyarticular onset of AR n (%)61 (49.6)61 (61.6)nsExtraarticular involvement n (%)17 (13.8)21 (21.2)nsPossitive RF n (%)89 (72.4)79 (79.8)nsPossitive ACPA n (%)70 (60.3)64 (68.1)nsDuration of RA (m) (mean (SD)96.1 (63.1)96,0 (73.9)nsMTX toxicity n (%)47 (38.2)59 (59.6)χ2 10.0 (p<0.01)OR 2.38 (1.4, 4.1))MTX dose (mg) (mean, SD)15.6 (0.32)17.8 (0.37)t=-4.52 p=00001ConclusionsThe initial treatment of RA with MTX is an effective and safe option, with a high drug survival. MTX response was not associated with antibody positivity (RF or ACPA), but it was significantly better in non-smokers patients and RF <100. Smoking cessation could signific...

BackgroundThe aim of early RA treatment is remission. Intensive treatment with MTX achieve remission in 30–50% patients (pts). Modifiable risk factors, as smoking, alcohol, coffee and tea, may affect response to MTX.ObjectivesTo study the influence of tobacco, alcohol, caffeine on the MTX response in early RA pats.MethodsA case-control study (2010–2015): cases were pts who achieved DAS28<2.6 (remission) and controls were pts who did not. We collected information from pts>18years with early RA, treated with MTX, evaluated quarterly in a specialized unit early RA. All the pts underwent a structured interview about their smoking history and others habits. A descriptive and comparative study, was performed (SPSS21).Results182 pts (age 50,96±13,11y, 67,6% female, 81,3% FR+ and 65,7% ACPA+) was treated with MTX and followed 105,03±7,15 months since 1995. More than 95% pts received MTX (in rapid escalation) in the first 24 months of the onset of symptoms. DAS28<2.6 was achieved for 67 (36,8%) pts, who required an lower average dose of MTX (15,07mg/w) than those who did not (18,04mg/w) (p=0,000). Age, DAS28 and physical function at baseline, treatment delay, smoking and adverse events by MTX were related to remission.The univariate and multivariate analysis of the baseline pts characteristics and the relationship of their smoking history with age, RF, ACPA and outcome of MTX monotherapy are shown in table 1and 2, respectively. The median survival of MTX monotherapy was 87,39 months (100.27 non-smokers and 47.70 months for current smokers (Log Rank 10.32, p 0.001) (see graphic).Table 1Baseline CharacteristicUnivariate analysisMultivariate analysis DAS28<2.6No remissionOR (95%IC)OR (95% CI) Age, mean (SD), years55.46 (13.21)48.34 (12.38)7.11 (3.26, 10.96)**0.124Female, n (%)41 (33.3)82 (66.7)ns0.173Current smoking, n (%)12 (21.4%)54478.6)2,84 (1.37–5.89)**0.37 (0.16, 0.86)*Caffeine, n (%)33 (29,2%)80 (70,8)2.35 (1.26 -4.39)**0.092Functional status > In (%)38 (29.0%)93 (71.0)3,23 (1.65–6.31)**2.39 (1.06, 5.40)*Extra-articular involv, n (%)7 (20,6%)27 (79.4)2,63 (1.08–6.43)*0.107MTX adverse events, n (%)20 (24,1%)63 (75,9)2.85 (1.50–5.40)**0.44 (0.20, 0.95)*Baseline DAS28PCR, mean (SD)3.88 (0.56)4,75 (0,76)-0,87 (-1.06, -0.67)**5.79 (2.99, 11.20)**MTX delay, mean (SD), m1.66 (3.91)5,39 (18.57)-3.73 (-7.28, -0.18)*0.089Table 2Smoking historyEdadACPAMTX doseRemission (n=67)Low activity (n=98)Need for biological (n=60) Never Smoking (n=67), % (SD),53,85 (15.23)*126.03 (146.91)*16,86 (3.92)28 (41.8)39 (58.2)19 (28.4) ns diff (95% CI)4.58 (0.32 to 8.82)-3.97 (-103.03 to -4.90)nsnsnsnsFormer Smoker (n=59), % (SD),65.97 (58.68)188.81 (159.17)15.97 (3.34)*27 (45.8)39 (66.1)*14 (23.3) diff (95% CI)nsns-1.44 (-0.29 to -2.59)ns1.67 (1.06 to 2.63)nsCurrent smoker (n=56), % (SD),45.34 (9.94)**171.03 (166.99)18.08 (3.63)**12 (21.4)**20 (35.7)**27 (48.2)** diff (95% CI)-8.11 (-2.02 to -4.12)ns1.63 (2.79 to 0.47)0.46 (.26 to 0.82)0.47 (0.3 to 0.75)2.62 (1.36 to 5.06)*p<0.05, **p<0.01.ConclusionsThe treatment of early RA with MTX alone ach...