RESEARCH - Sex: a major predictor of remission in early RA?

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Published Online First: 7 December 2006. doi:10.1136/ard.2006.056937

ls of the Rheumatic Diseases 2007;66:46-52

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EXTENDED REPORT

Sex: a major predictor of remission in early rheumatoid arthritis?

K Forslind 1, I Hafström 2, M Ahlmén 3, B Svensson 4 for the BARFOT Study Group

1 Section of Rheumatology, Helsingborgs Lasarett, Helsingborg, Sweden

2 Rheumatology Department, Karolinska University Hospital Huddinge,

Stockholm, Sweden

3 Rheumatology Department, Sahlgrenska University Hospital/Mölndal, Sweden

4 Rheumatology Department, University Hospital, Lund, Sweden

Background: The treatment goal of early rheumatoid arthritis is

remission. This study reports remission rates in clinical practice

using a cohort of patients with early rheumatoid arthritis.

Methods: 698 patients with early rheumatoid arthritis were included.

Mean age at inclusion was 58 years and mean disease duration was 6.4

months; 64% of the patients were women, 56% were positive for

antibodies to cyclic citrullinated peptide and 60% were positive for

rheumatoid factor. Remission was defined as a disease activity score

<2.6, with or without ongoing treatment with drugs for rheumatoid

arthritis.

Results: After 2 years, 261 of 689 patients were in remission (37.9%),

and after 5 years, the remission rate was 38.5%. However, only 26.1%

were in remission at both these time points. Multiple logistic

regression analyses found sex to be a main predictor for remission.

Thus, significantly fewer women were in remission after 2 years (32.1%

v 48%, p = 0.001) after 5 years (30.8% v 52.4%, p = 0.001) and at both

these time points (19.1% v 39.3%, p = 0.001). Although disease

activity was not with certainty more pronounced in women at onset of

disease, the disease course became markedly worse in women. The

disparity in remission frequency between women and men could not be

explained by differences in disease duration, age or treatment with

disease modifying antirheumatic drugs or glucocorticoids.

Conclusions: Early remission of rheumatoid arthritis by 28-joint

Disease Activity Score<2.6 was as frequent or more frequent in this

study than in most previous reports. Importantly, women had more

severe disease with a considerably lower remission rate than men,

although the disease activity before treatment seemed similar.

http://ard.bmj.com/cgi/content/abstract/66/1/46

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