Prevalence and predictors for sustained remission in rheumatoid arthritis

ObjectiveRemission is a key goal in managing rheumatoid arthritis (RA), with sustained remission as the preferred sequelae of short-term remission. However little is known about the predictors of sustained remission for patients reaching remission. Using two independent cohorts, we aimed to evaluate the prevalence and predictors for sustained remission.MethodsThe 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 who reached remission in 2009 with follow up data for two consecutive years. Remission was defined by the Disease Activity Score 28- (DAS28-CRP) of less than 2.6. Sustained remission was defined as three consecutive annual visits in remission. Predictors for sustained remission were identified by multivariate logistic regression analysis.ResultsA total of 465 subjects were in remission in 2009. 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).ConclusionMore 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.目标缓解（Objective Remission）是类风湿关节炎（rheumatoid arthritis, RA）管理的核心目标，持续缓解为短期缓解的理想转归。然而，目前针对已达到缓解的类风湿关节炎患者的持续缓解预测因素尚不清楚。本研究依托两个独立队列，旨在评估持续缓解的患病率及其预测因素。 方法：研究队列纳入来自布莱根妇女医院类风湿关节炎纵向研究（Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study, BRASS）以及韩国关节炎观察研究网络（Korean Observational Study Network for Arthritis, KORONA）的类风湿关节炎受试者。本研究分析了2009年达到缓解且拥有连续两年随访数据的受试者。缓解定义为C反应蛋白校正的28关节疾病活动度评分（Disease Activity Score 28-CRP, DAS28-CRP）<2.6；持续缓解定义为连续三次年度随访均处于缓解状态。采用多因素logistic回归分析识别持续缓解的预测因素。 结果：2009年共有465例受试者达到缓解。BRASS队列中92例受试者里有53例（57.5%）实现持续缓解，KORONA队列中373例受试者里有198例（53.1%）实现持续缓解。多因素分析结果显示，持续缓解的基线预测因素包括：病程<5年[比值比（odds ratio, OR）=1.96，95%置信区间（95% confidence interval, 95% CI）：1.08~3.58]、修正健康评估问卷（Modified Health Assessment Questionnaire, MHAQ）评分为0分（OR=1.80，95%CI：1.18~2.74）以及未使用口服糖皮质激素（OR=1.58，95%CI：1.01~2.47）。 结论：2009年达到缓解的类风湿关节炎患者中，超过半数在2011年时仍维持缓解状态。基线时病程较短、无残疾以及未使用口服糖皮质激素与持续缓解显著相关。