AB0211 The effect of smoking, alcohol and caffeine on early rheumatoid arthritis outcomes

Abstract

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...