Factors Predict Remission With DMARD Use | Arthritis Information

PARIS — Factors that predict which rheumatoid arthritis patients will achieve and maintain remission after disease-modifying drugs include low body mass index, low erythrocyte sedimentation rate levels, and absence of anti-cyclic citrullinated peptide antibody at baseline.

“Remission is increasingly becoming an attainable goal in rheumatoid arthritis treatment, and it would be useful to be able to predict which patients are likely to achieve remission in the long run, and so to be able to avoid overly aggressive treatment,” Dr. Diane van der Woude said at the annual European Congress of Rheumatology.

Although factors have been identified that predict the achievement of very low disease activity with biologics, little is known about the predictive factors of patients treated with DMARDs, said Dr. van der Woude of the department of rheumatology at Leiden (the Netherlands) University Medical Center.

She analyzed clinical, laboratory, and genetic data from patients enrolled in an inception cohort at the Leiden Early Arthritis Clinic between 1993 and 2003.

Among more than 1,900 patients referred to the clinic, 454 were diagnosed with RA and treated with chloroquine, sulfasalazine, or methotrexate, she said.

Sustained remission, or the absence of synovitis for longer than 1 year without DMARDs, was achieved by 69 patients (15%) with an average follow-up of 8 years. Six patients discharged because of remission had a recurrence of synovitis and were excluded from the remission group.

Univariate analysis revealed the following were significantly associated with less likelihood of achieving DMARD-free remission: positive family history (hazard ratio 0.56); high body mass index (HR 0.90); long duration of symptoms at presentation (HR 0.93); smoking (HR 0.55); and the presence of IgM rheumatoid factor (HR 0.17), anti-cyclic citrullinated peptide (CCP) antibodies (HR 0.09), and shared epitope alleles (HR 0.47).

Multivariate analysis identified older age, low BMI, low ESR, short duration of symptoms, nonsmoking status, and the absence of anti-CCP antibodies as independent predictors for DMARD-free remission.