PREVALENCE AND PREDICTORS FOR SUSTAINED REMISSION IN RHEUMATOID ARTHRITIS

Abstract

Background Disease progression of RA is unpredictable and recurrence occurs frequently even in patients in remission. Since patients with short term remission are more likely to experience radiographic structural progression compared with those achieving long-term remission, sustained remission is likely to improve patient outcomes and quality of life. Therefore, understanding the prevalence and predictors of sustained remission in typical clinical settings is important for physicians and patients to plan treatment strategies.Objectives In this study, we aimed to investigate the prevalence of sustained remission in established RA patients and to identify the predictors for sustained remission.Methods The study cohort consisted of subjects with RA from the Brigham and Women’s Hospital Rheumatoid Arthritis Sequential Study (BRASS) and the Korean Observational Study Network for Arthritis (KORONA). We analyzed subjects with remission in 2009 with 2 years of annual follow-up. Remission was assessed according to the Disease Activity Score 28 (DAS28-CRP) and sustained remission was defined as three consecutive annual visits with remission 2009-2011. Predictors for sustained remission were identified by multivariate logistic regression analysis.Results A total of 465 subjects with remission in 2009 were analyzed, and sustained remission was achieved by 53 of 92 (57.5%) in BRASS and by 198 of 373 (53.1%) in KORONA. In multivariate analyses, baseline predictors of sustained remission were: disease duration less than 5 years [odds ratio (OR) 1.96, 95% confidence interval (95% CI) 1.08-3.58], Modified Health Assessment Questionnaire (MHAQ) score of 0 (OR 1.80, 95% CI 1.18-2.74), and non-use of oral glucocorticoid (OR 1.58, 95% CI 1.01-2.47).Conclusions More than half of RA subjects in remission in 2009 remained in remission through 2011. Short disease duration, no disability, and non-use of oral glucocorticoid at baseline were associated with sustained remission.