Predictors and persistence of new-onset clinical remission in rheumatoid arthritis patients

https://doi.org/10.1016/j.semarthrit.2013.02.002Get rights and content

Abstract

Objective

To determine the prevalence and persistence of new-onset clinical remission in rheumatoid arthritis (RA) patients.

Methods

The Consortium of Rheumatology Researchers of North America (CORRONA) cohort was used to examine the prevalence of remission and associated comorbidities and RA therapies according to the 2011 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) remission criteria. Factors influencing the likelihood of remaining in remission were identified by logistic regression with generalized estimating equations. Analysis of variance and Tukey's test were used to determine differences in disability according to whether RA patients had been in remission or only low disease activity (LDA).

Results

A total of 2105 individuals met ACR/EULAR remission criteria at the most recent visit within CORRONA, yielding an 8% point prevalence of remission. Patients with certain comorbidities (e.g., heart failure) were significantly less likely to achieve or remain in remission compared to those without these conditions (p < 0.001 for each). Among prednisone users, the prevalence of remission was 1–6% (depending on dose) higher compared to those not on prednisone (10%). More than 50% of patients who had consistently been in remission for ≥1 year were able to remain in remission over the next year. Patients consistently in remission had less disability than patients who achieved LDA or who fluctuated between remission and LDA.

Conclusion

Patients consistently in remission for at least 1 year had a high likelihood to remain in remission. These individuals might be considered the most likely candidates for de-escalation or withdrawal of RA treatments.

Section snippets

Background

Clinical remission in rheumatoid arthritis (RA) is an achievable goal for some patients, especially in light of the availability of many new therapeutic options like anti-tumor necrosis factor (anti-TNF), anti CTLA-4 and anti-interleukin (IL)-6 receptor blockers. Remission in RA has been previously defined in several ways using different measurement instruments [1], [2], [3]; however these instruments' definition of remission varied in terms of their stringency [4]. In 2011, the American

Population and definition of remission

This study used data from the Consortium of Rheumatology Researchers of North America (CORRONA) from 2001 to 2011, which has been previously described [13], [14]. RA patients satisfying the 1987 American College of Rheumatology diagnosis criteria [15] were enrolled from academic and community rheumatology practices. Data from both physicians and patients were prospectively collected at enrollment and follow-up clinical encounters occurring at approximately 3–4-month intervals; at each visit,

Results

There were 2351 RA patients in remission according to the ACR/EULAR Boolean criteria at the most recently recorded CORRONA visit and 25,879 were not in remission. Table 1 shows the characteristics of patients in CORRONA according to remission status. The overall prevalence for new-onset RA remission was low (8%). Patients in remission uncommonly had comorbidities such as COPD, diabetes, or heart failure. The majority of patients in remission had low pain scores (86% with pain ≤1 on 0–10 visual

Discussion

After applying the ACR/EULAR Boolean remission criteria to a national US cohort, the overall point prevalence of clinical remission was low (8% overall). Based upon the presence or absence of varying comorbidities and use of different RA treatments, the prevalence of remission in various subgroups of RA patients was at most 11%. The likelihood of future remission varied modestly by RA therapies, especially for prednisone where higher doses were associated with a lower likelihood of remission.

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Supported by the Agency for Healthcare Research and Quality (R01HS018517) and the National Institutes of Health (AR053351). CORRONA has received general support in the last 2 years from Abbott, Amgen, Astra Zeneca, Genentech, Janssen (Centocor), Lilly and Pfizer. Dr. Greenberg is a shareholder in CORRONA and has received consulting fees from AstraZeneca, CORRONA, Novartis, Pfizer. Dr. Curtis receives support from the NIH (AR053351), the Agency for Healthcare Research and Quality (R01HS018517), and the Roche/Genentech, UCB, Janssen, CORRONA, Amgen.

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