How to Tell If an RA Patient is Likely to Achieve DMARD-Free Remission Without Biologics:
Remission has emerged as a reasonable goal for rheumatoid arthritis (RA) treatment in many cases, and a subset of patients are able to achieve persistent remission without the need for treatment with expensive biologics. That subgroup has now attracted research attention and Dutch investigators1 have now uncovered factors that make DMARD-free RA remission more likely. None of the patients in the study was treated with TNF inhibitors or other biologics.
RA remission most likely in the lean, smoke-free, promptly treated older patient
If you want to have RA that is likely to respond to less aggressive therapy, the study showed that you should
* develop symptoms when older, and start treatment promptly
* maintain a lean body weight
* have low levels of inflammatory markers
* not smoke, and
* not develop antiCCP (anticyclic citrullinated peptide) antibodies
The findings are from a research team led by Diane van der Woude, MD, a research fellow in the rheumatology department at Leiden University Medical Center in The Netherlands, and were reported at the 2008 EULAR meeting.
“These results demonstrate that persistent clinical remission does occur in a substantial proportion of patients treated with traditional DMARDs. Several clinical factors that are routinely assessed in clinical practice are robust predictors of achieving stable DMARD-free remission,” Dr. van der Woude said.
Dr. van der Woude and colleagues evaluated an inception cohort of more than 1900 patients who presented with RA to the Leiden Early Arthritis Clinic between 1993 and 2003. Those treated during 1993-1995 received a delayed treatment with chloroquine, sulfasalazine, or methotrexate. Those treated during 1996-2002 received the same regimen but the treatment was given early after diagnosis. The main outcome was DMARD-free remission, which was defined as persistent (>1 year) absence of synovitis without concurrent use of DMARDs, and subsequent discharge from the outpatient clinic.
The researchers examined a number of demographic, clinical, laboratory and genetic factors, including the HLA shared epitope alleles, PTPN22, C5-TRAF1, that might have contributed to the likelihood of sustained remission.
Over 15% of RA patients had sustained drug-free remission after conventional DMARDs
Dr. van der Woude reported that 69 of 454 RA patients (15.2%) achieved DMARD-free remission during an average follow-up of 8.2 years and a total of 3.817 patient years of study. Another six patients had originally been discharged from the outpatient clinic because of remission but had recurrence of synovitis and resumed treatment at the clinic.
“Multivariate analysis identified old age, low BMI, low ESR, short duration of complaints at presentation, nonsmoking, and absence of anti-CCP antibodies as independent predictors for achieving DMARD-free remission.” Univariate analysis identified a number of factors that reduce the chance for DMARD-free remission (Table 1)
“Clinical remission is increasingly becoming an attainable goal of RA treatment, especially since the advent of biological antirheumatic therapy. Although some factors have been identified that predict the achievement of very low disease activity scores in patients who are treated with novel therapeutic agents, little is known about the patients who achieve persistent DMARD-free remission with less aggressive therapy. In this study, we describe the characteristics and predictive factors for stable DMARD-free remission in RA patients who were treated with traditional DMARDs,” Dr. van der Woude said.
Reference
1. van der Woude D, Brand R, Toes REM, et al. Risk factors for DMARD-free remission in RA, lessons from an inception cohort. Presented at: EULAR 2008; June 11, 2008; Paris, France. Presentation OP-0002.
What's the difference between persistant remission and being cured?
But what about all these people that already have a lean body mass, are older at onset, don't smoke, with negative antiCCP and with moderate inflammatory markers? Are they just destined to be on biologics for the rest of their lives? It also goes to prove that obesity is a huge factor in inflammation. Also, what's "older"? I was 43. Does that qualify? I'm also wondering about the low inflammatory markers. Does that mean low since you've been on meds, or low overall throughout your whole disease? Cuz mine were really high before the meds, but have been really good since they started working. Except once when they just shot up during a bad flare.Okay then-I'm good on all except the CCP, and I'm doing great on MTX. That is a DMARD though. It seems like they are forgetting that some DMARDs aren't biologics.No Cure, hmmmmmmm
i am 120