ACR: Less Pain, Disability and Negative Rheumatoid Factor Predict Remission of Recent-onset Rheumatoid Arthritis

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ACR: Less Pain, Disability and Negative Rheumatoid Factor Predict Remission

of Recent-onset Rheumatoid Arthritis

By Dan Keller

Special to DG News

NEW ORLEANS, LA -- October 29, 2002 -- Less pain, less functional

disability, and negative rheumatoid factor (RF) at baseline appears to

increase the likelihood of remission for patients with early onset

rheumatoid arthritis.

Baseline erythrocyte sedimentation rate (ESR) also predicted remission. More

aggressive therapy with disease modifying anti-rheumatoid drugs (DMARDs) at

baseline led to shorter delays until the first remission.

Suzan Verstappen, MD, from the department of rheumatology and clinical

immunology at University Medical Center, in Utrecht, the Netherlands,

presented the results of a study of rheumatoid arthritis patients with onset

of less than one year during a session October 28 at the 66th Annual

Scientific Meeting of the American College of Rheumatology (ACR), in New

Orleans, Louisiana.

Her team randomised 168 patients to no disease modifying anti-rheumatoid

drugs (DMARD; N=63), less aggressive DMARD (hydroxychloroquine), 332 to more

aggressive DMARD therapy (methotrexate or intramuscular gold). Treatment

changes were possible at one year if clinically necessary.

During a mean follow-up time of 59 months, 60 percent of patients achieved

remission, based on duration of morning stiffness, pain intensity,

joint score, and the ESR. Mean duration of remission was 28.5 months with a

range of 6-96 months. The mean number of remissions was 1.4. " After

approximately two years, about 40 percent of the patients are in remission

at each assessment point, " Dr. Verstappen said. " On average patients spent

49 percent of their follow-up time in remission. "

The mean lag time to remission was related to the intensity of DMARD

therapy: 25 months for patients on no DMARDs, 20 months for less aggressive

DMARDs, and 15 months for more aggressive DMARDs (p<0.05).

Of the patients who achieved remission, 43 percent sustained it for an

average of 35 months. Patients with remissions had significantly less

radiological progression and greater improvement in functional disability

compared to baseline.