Document Detail

Prevalence of and predictive factors for sustained disease-modifying antirheumatic drug-free remission in rheumatoid arthritis: results from two large early arthritis cohorts.
MedLine Citation:
PMID:  19644846     Owner:  NLM     Status:  MEDLINE    
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 Cox 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.
Diane van der Woude; Adam Young; Keeranur Jayakumar; Bart J Mertens; René E M Toes; Désirée van der Heijde; Tom W J Huizinga; Annette H M van der Helm-van Mil
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  60     ISSN:  0004-3591     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-08-11     Completed Date:  2009-09-25     Revised Date:  2011-12-01    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2262-71     Citation Subset:  AIM; IM    
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
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MeSH Terms
Anti-Inflammatory Agents / therapeutic use*
Antirheumatic Agents / therapeutic use*
Arthritis, Rheumatoid / drug therapy*,  metabolism,  physiopathology
Cohort Studies
Health Status
Joints / pathology
Middle Aged
Peptides, Cyclic / blood,  immunology
Predictive Value of Tests
Recovery of Function
Remission Induction
Rheumatoid Factor / blood
Severity of Illness Index
Grant Support
//Arthritis Research UK
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Antirheumatic Agents; 0/Peptides, Cyclic; 0/cyclic citrullinated peptide; 9009-79-4/Rheumatoid Factor

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