The impact of different criteria sets on early remission and identifying its predictors in rheumatoid arthritis: results from an observational cohort (2009–2018)
To assess rates of early remission and investigate the concordance across different remission definitions, and to identify predictors of early remission in Chinese patients with rheumatoid arthritis (RA).
For this study, clinical records were retrospectively reviewed for RA patients at rheumatologic clinic in Peking University First Hospital from 2009 to 2018. Disease activity and remission were determined according to DAS28-ESR, CDAI, SDAI, and Boolean criteria. Early remission was defined as time to remission ≤ 6 months. A secondary definition evaluated early remission as ≤ 3 months. Logistic-regression analyses were performed to identify determinants of early remission.
A total of 869 consecutive patients contributing 8640 clinic visits were studied. Early remission rates were respectively 42.0% (DAS28-ESR), 25.0% (CDAI), 29.4% (SDAI), and 26.1% (Boolean). Notably, patients achieving remission within 6 months more frequently attained sustained remission in contrast to those not achieving early remission (68.7–75.1% vs. 31.2–33.1%, p < 0.0001). Further logistic-regression analyses revealed male, early RA, as well as initial hydroxycloroquine treatment were independently associated higher probability of early remission, as demonstrated by nearly all definitions, while a higher baseline disease activity (DAS28-ESR, CDAI, and SDAI) lowered the possibility of early remission in corresponding remission indices. The significant associations of treatment-naïve, serological features with early remission were not confirmed.
• Early remission was infrequently achievable in real-life practice, especially measured by stringent indices.DAS28-based early remission appears to be the loosest criterion and the remaining three broadly agreed with each other.
• Early remission was significantly associated with sustained remission.
• Male, early RA, a low baseline disease activity, and initial hydroxycloroquine treatment were positively correlated with early remission.
KeywordsClinical monitoring Outcomes Predictors Remission Rheumatoid arthritis
disease activity score in 28 joints using erythrocyte sedimentation rate level
the clinical disease activity index
the simplified disease activity index
American College of Rheumatology
European League Against Rheumatism
cyclic citrullinated peptides
tender joint counts based on 28 joints
swollen joint counts based on 28 joints
patient’s global assessment of disease
evaluator’s global assessment of disease
disease-modifying antirheumatic drugs
Authors wish to thank all the patients, rheumatology nurses, and rheumatologists who contributed to our study.
This work was supported by the National Nature Science Foundation of China (81771740) and Beijing Natural Science Foundation (7184251).
Compliance with ethical standards
The manuscript must be read and approved by all of the authors.
Ethical committee approval
This study was approved by the Ethics Committee of Peking University First Hospital.
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