Sustained clinical remission of rheumatoid arthritis and its predictive factors in an unselected adult Chinese population from 2009 to 2018

Abstract

Aim To investigate the prevalence and predictors of sustained remission (SR) in an unselected Chinese rheumatoid arthritis (RA) population. Patients and methods Medical records of RA patients from 2009 to 2016 were retrospectively reviewed. Clinical remission was defined according to Disease Activity Score in 28 joints using erythrocyte sedimentation rate (DAS28‐ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and Boolean criteria. Remission persisting for at least 6 months was regarded as SR (6‐month SR). Kaplan‐Meier method and Cox regression analyses were performed to plot cumulative possibility of achieving 6‐month SR and to identify predictors. Results Seven hundred and seventy‐nine patients contributing 7958 clinic visits were included. During the follow‐up period, nearly half of patients achieved 6‐month SR according to DAS28‐ESR (51.6%), CDAI (45.6%), SDAI (44.0%), as well as Boolean definitions (42.4%). Median time periods to 6‐month SR were respectively 20.5, 28.7, 30.6, and 32.9 months based on the above criteria. Specifically, 29.4% to 41.2% of patients achieved 6‐month SR at least once in the first year of follow‐up, depending on instruments. Multivariate Cox regression indicated that increasing age, longer disease duration, higher baseline disease activity were independently correlated with reduced possibility of 6‐month SR assessed by nearly all definitions. Conversely, male, early RA, disease‐modifying antirheumatic drug‐naïve and lower disease activity scores in remission measured by corresponding criteria positively contributed to SR. Importantly, treat‐to‐target (T2T) adherence therapy and shorter time to remission were identified as stable determinants of SR across all definitions. Conclusions Achieving 6‐month SR was not uncommon in daily practice. Male, early RA, treatment‐naïve, T2T application, shorter time to remission, and lower disease activity scores in remission increased the occurrence of SR, while increasing age, longer disease duration, and higher baseline disease activity reduced the chance of remission sustainability.

Dynamical trajectory of glucocorticoids tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020

“…The cohort, first established over a decade ago, has been described in greater detail in our previous researches. [16][17][18][19][20][21] Briefly, demographics, symptom duration, RA core set variables, laboratory findings and treatment details were documented at the initial visit in the database. After that, all patients are prospectively followed up and documented at least 3 monthly for those in moderate/high diseases activity and every 3-12 months (usually 3-6 months) for those in remission/low disease activity (LDA).…”

Fluctuation in anti-cyclic citrullinated protein antibody level predicts relapse from remission in rheumatoid arthritis: KURAMA cohort

“…To date, several factors have been proposed as predictors for sustained remission, including sex, short disease duration, not smoking, less tender joint count (TJC) at baseline, RF positivity, and absence of radiographic damage at baseline and initial treatment [18]. Thus, we investigated whether these factors could contribute to the relapse from the remission.…”

Dynamic Characteristics and Predictive Profile of Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients Commencing Glucocorticoids with csDMARD: A Real-World Experience

“…This study is a retrospective analysis of prospectively collected data from Treat-to-TARget in RA (TARRA) cohort of RA patients. The cohort, first established over a decade ago, is a monocentric longitudinal cohort and has been described in greater detail in our previous research [13][14][15][16][17][18][19]. Briefly, demographics, symptom duration, RA core variables, and treatment details were collected at the first visit.…”