RT Journal Article
SR Electronic
T1 Remission in Early Rheumatoid Arthritis: Predicting Treatment Response
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 470
OP 475
DO 10.3899/jrheum.110169
VO 39
IS 3
A1 MARGARET H.Y. MA
A1 FOWZIA IBRAHIM
A1 DAVID WALKER
A1 ANDREW HASSELL
A1 ERNEST H. CHOY
A1 PATRICK D.W. KIELY
A1 RICHARD WILLIAMS
A1 DAVID A. WALSH
A1 ADAM YOUNG
A1 DAVID L. SCOTT
YR 2012
UL http://www.jrheum.org/content/39/3/470.abstract
AB Objective. Optimizing therapeutic strategies to induce remission requires an understanding of the initial features predicting remission. Currently no suitable model exists. We aim to develop a remission score using predictors of remission in early rheumatoid arthritis (RA). Methods. We used a dataset from a UK randomized controlled trial that evaluated intensive treatment with conventional combination therapy, to develop a predictive model for 24-month remission. We studied 378 patients in the trial who received 24 months’ treatment. Our model was validated using data from a UK observational cohort (Early RA Network, ERAN). A group of 194 patients was followed for 24 months. Remission was defined as 28-joint Disease Activity Score < 2.6. Logistic regression models were used to estimate the associations between remission and potential baseline predictors. Results. Multivariate logistic regression analyses showed age, sex, and tender joint count (TJC) were independently associated with 24-month remission. The multivariate remission score developed using the trial data correctly classified 80% of patients. These findings were replicated using ERAN. The remission score has high specificity (98%) but low sensitivity (13%). Combining data from the trial and ERAN, we also developed a simplified remission score that showed that younger men with a TJC of 5 or lower were most likely to achieve 24-month remission. Remission was least likely in older women with high TJC. Rheumatoid factor, rheumatoid nodules, and radiographic damage did not predict remission. Conclusion. Remission can be predicted using a score based on age, sex, and TJC. The score is relevant in clinical trial and routine practice settings.