Patient-reported outcomes as predictors of remission in early rheumatoid arthritis patients treated with tight control treat-to-target approach

• Published in: Rheumatology international Vol. 37; no. 5; pp. 825 - 830
• Main Authors: Kuusalo, Laura, Puolakka, Kari, Kautiainen, Hannu, Karjalainen, Anna, Malmi, Timo, Yli-Kerttula, Timo, Leirisalo-Repo, Marjatta, Rantalaiho, Vappu
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2017; Springer Nature B.V
• Subjects: Adolescent; Adult; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Female; Humans; Male; Medicine; Medicine & Public Health; Methotrexate - therapeutic use; Middle Aged; Observational Research; Patient Reported Outcome Measures; Predictive Value of Tests; Prognosis; Quality of Life; Remission Induction; Rheumatology; Severity of Illness Index; Treatment Outcome; Young Adult; Clinical trial; Remission; Rheumatoid arthritis; Patient reported outcomes; Health-Related Quality Of Life
• ISSN: 0172-8172; 1437-160X
• DOI: 10.1007/s00296-017-3692-7

Identifying prognostic factors for remission in early rheumatoid arthritis (ERA) patients is of key clinical importance. We studied patient-reported outcomes (PROs) as predictors of remission in a clinical trial. We randomized 99 untreated ERA patients to receive remission-targeted treatment with three disease-modifying antirheumatic drugs and prednisolone for 24 months, and infliximab or placebo for the initial 6 months. At baseline, we measured following PROs: eight Short Form 36 questionnaire (SF-36) dimensions, patient’s global assessment [PGA, visual analogue scale (VAS)], Health Assessment Questionnaire (HAQ), and pain VAS. We used multivariable-adjusted regression models to identify PROs that independently predicted modified American College of Rheumatology remission at 2 years. Follow-up data at 2 years were available for 93 patients (92%), and 58 patients (62%) were in remission. At baseline, patients who achieved remission had higher radiological score ( p  = 0.04), lower tender joint count ( p  = 0.001), lower PGA ( p  = 0.005) and physician’s global assessment ( p  = 0.019), lower HAQ ( p  = 0.016), less morning stiffness ( p  = 0.009), and significantly higher scores in seven out of eight SF-36 dimensions compared with patients who did not. In multivariable models that included all PROs, remission was associated with SF-36 dimensions higher vitality (odds ratio 2.01; 95% confidence interval 1.19–3.39) and better emotional role functioning (odds ratio 1.64; 95% confidence interval 1.01–2.68). PGA, pain VAS, HAQ, and other SF-36 dimensions were not associated with remission. We conclude that self-reported vitality and better emotional role functioning are among the most important PROs for the prediction of remission in ERA.