RESEARCH - Prevalence of and predictive factors for sustained DMARD-free remission in RA

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Arthritis Rheum. 2009 Aug;60(8):2262-71.

Prevalence of and predictive factors for sustained disease-modifying

antirheumatic drug-free remission in rheumatoid arthritis: results

from two large early arthritis cohorts.

van der Woude D, Young A, Jayakumar K, Mertens BJ, Toes RE, van der

Heijde D, Huizinga TW, van der Helm-van Mil AH.

Department of Rheumatology, Leiden University Medical Center, Leiden,

The Netherlands.

OBJECTIVE: Remission has become an attainable goal of rheumatoid

arthritis (RA) treatment, especially since the advent of biologic

antirheumatic therapy. Because little is known about patients who

achieve disease remission with conventional treatment, we used 2 large

independent inception cohorts to study the prevalence of and

predictive factors for disease-modifying antirheumatic drug

(DMARD)-free sustained remission after treatment with conventional

therapy.

METHODS: Remission of disease was assessed in 454 patients from the

Leiden Early Arthritis Clinic (EAC) and in 895 patients from the

British Early Rheumatoid Arthritis Study (ERAS) who fulfilled the

American College of Rheumatology 1987 revised criteria for the

classification of RA and were treated with conventional therapy.

Sustained DMARD-free remission was defined as fulfilling the following

criteria for at least 1 year: 1) no current DMARD use, 2) no swollen

joints, and 3) classification as DMARD-free remission by the patient's

rheumatologist. Predictive factors were identified by regression

analysis.

RESULTS: Sustained DMARD-free remission was achieved by 68 of 454

patients (15.0%) in the Leiden EAC and by 84 of 895 patients (9.4%) in

the ERAS. Six factors were associated with sustained DMARD-free

remission in both cohorts: acute onset, short symptom duration before

inclusion, not smoking, little radiographic damage at baseline,

absence of IgM rheumatoid factor (IgM-RF), and absence of HLA shared

epitope alleles. In the ERAS, low disease activity at baseline was

also predictive of remission. Multivariate analyses revealed symptom

duration and the absence of autoantibodies (anti-cyclic citrullinated

peptide 2 and IgM-RF) as independent predictors.

CONCLUSION: Sustained DMARD-free remission in RA patients treated with

conventional therapy is not uncommon. Symptom duration at presentation

and the absence of autoantibodies are associated with sustained

DMARD-free remission.

PMID: 19644846

http://www.ncbi.nlm.nih.gov/pubmed/19644846

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