EXTENDED REPORT - Prognostic factors for remission in early RA: a multiparameter prospective study

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ls of the Rheumatic Diseases 2004;63:675-680

© 2004 by BMJ Publishing Group Ltd & European League Against Rheumatism

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EXTENDED REPORT

Prognostic factors for remission in early rheumatoid arthritis: a

multiparameter prospective study

Objective: To determine prognostic factors for remission in early rheumatoid

arthritis.

Methods: 191 patients with rheumatoid arthritis whose disease duration was

less than one year were followed up prospectively for five years. Remission,

defined by a disease activity score (DAS) of <1.6, was used as the outcome

measure. Baseline clinical, laboratory, genetic, and radiographic data (with

radiographic scores determined by Sharp's method, modified by van der

Heijde) were obtained.

Results: 48 patients (25.1%) fulfilled the remission criteria at the three

year follow up visit, and 30 (15.7%) at three and five years. On univariate

analysis by Fisher's exact test, remission at three years and persistent

remission at five years were closely correlated with baseline DAS values, C

reactive protein level, Ritchie score, health assessment questionnaire

score, duration of morning stiffness, and to a lesser extent baseline total

radiological scores and rheumatoid factor negativity. No significant

correlation was found with sex, age, extra-articular manifestations,

erythrocyte sedimentation rate, anti-cyclic citrullinated protein

antibodies, anti-keratin antibodies, anti-HSP 90, anticalpastatin

antibodies, antinuclear antibodies, or HLA-DRB1* genotypes. Logistic

regression analysis showed that the baseline independent variables

predictive of remission were low DAS, Ritchie score, morning stiffness

duration, and total radiographic score.

Conclusions: Baseline prognostic factors for remission in early rheumatoid

arthritis were mainly clinical markers of disease activity and radiological

scores.

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Rheumatoid arthritis is currently recognised as a heterogeneous entity that

is usually diagnosed with reference to the American College of Rheumatology

(ACR) classification criteria.1 The clinical course of rheumatoid arthritis

is variable and its prognosis is difficult to predict.2,3 In many patients,

the disease process is severe and results in progressive joint destruction

and serious disability, but outcomes vary widely. Predicting the outcome of

this disease is crucial for optimal clinical management. Patients with a

high likelihood of an untoward outcome should be given appropriately

aggressive treatment at an early stage; this is even more important now that

new treatments have been shown to reduce progression of the disease.4-6 The

ultimate goal of treatment is remission-that is, complete suppression of

disease activity.7 The American Rheumatism Association (ARA) has defined

preliminary remission criteria.8 These criteria are based on six variables,

of which two (fatigue and joint pain on motion) are not included in the core

sets of variables uniformly collected in clinical studies.9 Prevoo et al

proposed the disease activity score (DAS10) as a standardised evaluation

tool to define remission, after showing in 227 patients that those with a

DAS of <1.6 were in remission according to the ARA criteria.

http://ard.bmjjournals.com/cgi/content/full/63/6/675

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