Proportion of patients with clinical remission and sustained clinical remission measured by various validated indices in patients with rheumatoid arthritis: a single-institution observational study / 中华风湿病学杂志

ABSTRACT

Objective:To investigate the proportion of patients with clinical remission and sustained remission in Chinses patients with rheumatoid arthritis (RA).Methods:We retrospectively reviewed the medical records of RA patients in our center from January 1, 2011 to December 31, 2016. Disease activity scores and remission status at each visit were assessed by the disease activity score in 28 joints (DAS28), the simplified disease activity index (SDAI), the clinical disease activity index (CDAI), and the American Ccollege of Rheumatology/European league Against Rheumatism (ACR/EULAR) Boolean criteria. Patients were considered in sustained remission if they maintained remission during consecutive visits for 6 months. Kaplan-Meier method was applied to plot cumulative possibility of achieving remission and calculate the median time to first clinical remission. Cox multivariate regression analysis was used to analyze the relative factors of sustained remission.Results:A total of 648 patients were included in the present study. During the median follow-up of 24 months, around 70% of patients reached clinical remission at least once (DAS28 78.7%, SDAI 70.8%, CDAI 68.4%, Boolean criteria 68.7%). Specifically, the cumulative probability of achieving remission at 3-, 6- and 12- month was 10.6%-24.4%, 25.3%-43.5% and 51.8%-65.2% respectively, depending on instruments applied. The median time to first remission was 7.2 (DAS28), 10.1(SDAI), 11.7(CDAI), 11.4(Boolean criteria) months. Regarding the sustained remission, nearly half of patients experienced SR defined by DAS28(52.2%), CDAI(46.6%), SDAI(45.1%), and Boolean definitions (43.7%) respectively. Among those patients in sustained remission, the median time of persistence remission during study period was 16.0 months (DAS28-ESR), 15.4 months (CDAI), 14.9 months (SDAI) and 15.0 months (Boolean criteria). Among patients achieving sustained remission, the percentage was 18.7% and 81.3% for DMARD monotherapy and combination therapy, respectively. Additionally, 22.3% of patients received low-dose glucocorticoids treatment concomitantly and over half of them successfully tapered or discontinued the glucocorticoids during the period of sustained remission.Conclusion:In daily practice, clinical remission is a realistic target in the setting of treat-to-target strategy, and over half of patients achieveclinical remission in the first year of follow-up. Among those patients who achieve clinical remission, around half of them reach sustained remission over the subsequent follow-up period. The median time of persistent remission in patients achieving remission is about 15 months.