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Out of the patient-reported outcomes
(PROs); only vitality and emotional role functioning are connected with
higher remission rates in initial RA revealing patients’ certain personality
traits or more positive attitude to life.
In
early rheumatoid arthritis (ERA) patient, identification of prognostic factors
for remission is clinically crucial and beneficial. Therefore, patient-reported
outcomes (PROs) could be used as predictors of remission.
Kuusal
L and colleagues conducted a randomized clinical trial involving 99 untreated
ERA patients. They received a remission-targeted treatment which included three
disease-modifying anti-rheumatic drugs (DMARDs) and prednisolone for 24 months
along with initial six months' dose of either infliximab or placebo. The PROs
measured at baseline were: 1) Eight Short Form 36 questionnaire (SF-36)
dimensions, 2) Patient’s global assessment [PGA, visual analogue scale (VAS)],
3) Health Assessment Questionnaire (HAQ), and 4) Pain VAS.
Multivariable-adjusted regression models were used to identify the PROs, which
independently predicted modified American College of Rheumatology remission at
two years.
Follow-up
data at two years found in remission was 92% (93 patients), and 62% (58
patients). At baseline, patients who achieved remission got high radiological
score (p = 0.04),
lower tender joint count (p = 0.001),
lower PGA (p = 0.005)
and physician’s global assessment (p = 0.019),
lower HAQ (p = 0.016),
less morning stiffness (p = 0.009),
and had significantly higher scores (seven out of eight SF-36 dimensions
compared with patients who did not. In multivariable models that included all
PROs, remission was associated with SF-36 dimension's higher vitality (odds
ratio 2.01; 95% confidence interval 1.19–3.39) and better emotional role
functioning (odds ratio 1.64; 95% confidence interval 1.01–2.68). Overall, PGA,
pain VAS, HAQ and other SF-36 dimensions were not associated with remission.
Therefore,
it was concluded that self-reported vitality and better emotional role
functioning criteria were important PROs to predict the remission of ERA.
Rheumatology International
Patient-reported outcomes as predictors of remission in early rheumatoid arthritis patients treated with tight control treat-to-target approach
Laura Kuusal et al.
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