Predictors of DMARD-Free Remission Are Identified | Arthritis Information

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A fully sustained, disease-modifying-antirheumatic-drug-free remission occurred in 15% of patients using conventional, nonbiologic therapy, according to results from a large 10-year study.

“We were surprised by the high number of patients who achieved remission,” Dr. Diane van der Woude of Leiden University Medical Centre (Netherlands), and the study's lead author, said in an interview. The data was reported at the annual European Congress of Rheumatology. “The patients we studied were enrolled between 1993 and 2003, a time when there were no biological agents available and disease activity was not strictly monitored. That 15% of patients treated with conventional therapy achieved remission is a useful number to keep in mind as a reference when reading reports of remission percentages after treatment with novel agents.”

She looked at 454 RA patients. Patients were treated with a delayed or early treatment strategy with chloroquine, sulfasalazine, or methotrexate. They defined DMARD-free remission as absence of synovitis without concomitant use of disease-modifying antirheumatic drugs (DMARDs) for more than 1 year. Average follow-up was 8 years. Of the 454 RA patients, 69 (15%) achieved DMARD-free remission.

Univariate analysis revealed that the following were significantly associated with achieving DMARD-free remission: negative family history (hazard ratio of 1.8), short duration of complaints before presentation (HR 1.08 per month), nonsmoking (HR 1.8), low C-reactive protein at baseline (HR 1.01 per mg/L), absence of IgM rheumatoid factor and anti-CCP antibodies (HR 5.9 and 11.6, respectively), and absence of HLA shared epitope alleles (HR 2.1).

Multivariate analysis revealed that low C-reactive protein at baseline and absence of anti-CCP antibodies were significant independent predictors for DMARD-free remission.

“We are currently working on replication of these data in another large [non-Dutch] early arthritis cohort, also consisting of patients treated with conventional antirheumatic therapy,” Dr. van der Woude said in an interview. “It will be interesting to see if we and our collaborators will find a similar prevalence of DMARD-free remission and similar predictive characteristics,” she added.

Oooh, I have all except the smoking!  Oooooohhhhhh!
 
Hugs,
 
Pip
Which leads to a very interesting question...How many people with RA smoke????

Hi Lynn! I followed you here - LOL!

I was smoking when I was diagnosed with RA. I quit immediately - as my rheumy wouldn't give me an RX for MX if I continued to smoke (because of the risk of pleurisy). I quit that day and have never looked back. I'm an easy scare.
Hugs Lynn!
~Brenna
I think we ran a poll about a year back and the results were 50/50.  Meaning - half had never smoked in there lives.
 
Go figure.
 
Pip
Unfortunately I am still smoking. Tried everything.Interesting. 
 
I never smoked, don't have a family history, am RF negative, and HLBA27 negative (if that's what that last one was).  I don't know about baseline C-RP or anti-CCP.  I did have a short duration of symptoms before presentation (2 months because I was already seeing RD for fibro) but it was 9 months before treatment began (due to testing for diagnosis).
 
Methotrexate, Arava and Imuran have not even significantly helped.  I have not tried chloroquine or sulfasalazine.
I quit smoking 23 years ago, no family history, no prior presentations, not sure what my initial blood numbers were- just remember being told the inflammation markers were extremely high.
With MTX and Prednisone went into a drug induced remission at about 3 months into treatment. Next blood work after tapering the prednisone I was at near perfect numbers but slightly out of range so not in remission. Due to be tested anytime I get off my butt and go.

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