Early remission and its predictive factors in Chinese population with rheumatoid arthritis / 中华风湿病学杂志

ABSTRACT

Objective To investigate the early remission rate of rheumatoid arthritis (RA) and identify the potential predictive factors in Chinese population. Methods For this study, medical records of RA patients during January 1, 2009 to December 31, 2016 were retrospectively reviewed. Disease activity scores at visits were measured by (disease activity score uses 28 joint counts (DAS28)-erythrocyte sedimentation rate (ESR) and remission status was determined subsequently. Early remission was defined as the time interval between first visit and clinical remission for less than 6 months. Logistic regression analysis was applied to identify predictive factors for early remission. Results Seven hundred and seventy nine patients in total were included into the present study. Overall, 317 (40.7％) patients achieved early remission and the median time to early remission was 2.8 (1.8, 1.4) months. Comparison of characteristics between RA patients with and without early remission, male gender (26.5％ vs 16.5％, x2=11.631, P=0.001), treatment-na?ve (64.7％ vs 53.5％, x2=9.692, P=0.002), early RA (50.4％ vs 40.9％, x2=7.656, P=0.01), as well as initial use of hydroxy-chloroquine (44.8％ vs 34.0％, x2=9.293, P=0.003) was significantly higher in patients with early remission. Conversely early remission was less frequent in patients with late onset [(49±16) vs (47±16), t=2.925, P=0.003], long disease duration [24(6, 96) vs 14 (4,72), Z=3.126, P=0.003] high level of all baseline individual com-ponents of disease activity [(TJC, SJC, PGA, EGA, ESR, C-reactive protein (CRP)] and DAS28-ESR [(4.33± 1.21) vs (4.92 ±1.38), t=6.118, P<0.01], as well as initial treated with glucocorti-coids (44.6％ vs 36.0％, x2=5.780, P<0.05). No significant differences were observed in terms of serological features, initial used of MTX, LEF, SSZ, as well as DAMRDs combination. Further logistic regression analyses identified that male [OR=1.70, 95％CI (1.16, 2.47)], treatment-na?ve [OR=1.64, 95％CI (1.20, 2.24)], and treatment with hydroxy-chloroquine initially [OR=1.87, 95％CI(1.37, 2.56)] as independent factors associated with early remission. In contrast, late disease onset [OR=0.99, 95％CI(0.98, 1.00)], high baseline DAS28-ESR [OR=0.70, 95％CI(0.62, 0.79)] were independently associated with decreased possibility of early remission ( P<0.05). Conclusion Early remission is uncommon in clinical practice. Male, treatment-na?ve, and initial hydroxychloroquine treatment increases the probability of early remission, while advanced age, higher baseline DAS28-ESR decreases the chance of early remission.