Reumatología Clínica

Reumatología Clínica

Volume 16, Issue 5, Part 2, September–October 2020, Pages 405-409
Reumatología Clínica

Brief Report
Prognostic Factors for Sustained Remission in a “Real Life” Cohort of Rheumatoid Arthritis PatientsFactores pronósticos para la remisión sostenida en una cohorte de “vida real” de pacientes con artritis reumatoide

https://doi.org/10.1016/j.reuma.2018.10.002Get rights and content

Abstract

Introduction

Rheumatoid arthritis (RA) is the most frequent chronic polyarthritis. The current goal of RA treatment is to achieve clinical remission.

Objective

The goal of this study was to determine the prevalence of remission in a cohort of patients from clinical practice, and to identify potentially modifiable factors associated with remission.

Methods

A retrospective study was performed on a cohort of RA patients seen at the first consultation at the HUGC Rheumatology Service Dr. Negrín (HUGCDN) between first of January 2000 and thirtieth of April 2014. Sustained remission was defined as DAS28 less than 2.6 in the last two available visits in the medical history.

Results

A total of 463 patients were consecutively included, most (75%) women, with a mean age at the onset of RA of 50 years and a mean duration of the disease at follow-up of 8 years. 46% of the patients achieved sustained remission. Multiple logistic regression analyses found male sex (P = .031, OR 1.7, 95% CI 1.05–2.82), diagnosis in the first year of symptoms (P = .023, OR 1.7, 95% CI 1.07–2.69) and the initial DAS28 (P = .035) to be independent predictors for sustained remission.

Conclusions

The 46% of the patients with RA followed in the HUGC Dr. Negrín are in persistent remission, being the early diagnosis a modifiable factor predictor of remission. Thus, an objective of the Rheumatology Service should be to improve the diagnostic delay of RA in the health area.

Resumen

Introducción La artritis reumatoide (AR) es la poliartritis crónica más frecuente. El objetivo actual del tratamiento de la AR es lograr la remisión clínica.

Objetivo

El objetivo de este estudio fue determinar la prevalencia de la remisión en una cohorte de pacientes de la práctica clínica, e identificar factores potencialmente modificables asociados con la remisión.

Métodos

Se realizó un estudio retrospectivo en una cohorte de pacientes con AR observada en la primera consulta del Servicio de Reumatología del Hospital Universitario de Gran Canaria Dr. Negrín (HUGCDN) entre el primero de enero de 2000 y el 30 de abril de 2014. La remisión mantenida se definió como DAS28 menor de 2,6 en las 2 últimas visitas recogidas en la historia clínica.

Resultados

Se incluyeron consecutivamente 463 pacientes, la mayoría (75%) mujeres, con una edad media al inicio de la AR de 50 años y la duración media de la enfermedad en el seguimiento de 8 años. El 46% de los pacientes alcanzaron la remisión sostenida. Los análisis de regresión logística múltiple encontraron que el sexo masculino (p = 0,031; OR: 1,7; IC del 95%: 1,05-2,82), el diagnóstico en el primer año de síntomas (p = 0,023; OR: 1,7; IC del 95%: 1,07-2,69) y el DAS28 inicial (p = 0,035) fueron factores predictores independientes de remisión sostenida.

Conclusiones

El 46% de los pacientes con AR seguidos en el HUGCDN están en remisión persistente, siendo el diagnóstico precoz un factor predictor modificable de la remisión. Así, un objetivo del servicio de reumatología debe ser mejorar el retraso diagnóstico de la AR en el área de salud.

Introduction

Rheumatoid arthritis (RA) is the most frequent chronic inflammatory disease, affecting 0.5%–1% of the European and North American population. Its prevalence in Spain and in the Canary Islands is 0.5%.1 RA is characterized by persistent joint inflammation associated with further joint damage and disability. Not only the development of new drugs, but also the early diagnosis and treatment, provides better control of the disease and better long-term prognosis. The goal of RA treatment of the lowest disease activity possible has improved the results compared to the classic management. The treat to target strategy has a goal defined as clinical remission or low disease activity. The evaluation scales and their remission criteria have been in continuous revision, because depending on the index that is being used, patients with the same activity may obtain different punctuations. The purpose of this study was to determine the prevalence of clinical remission in a “real life” cohort of RA patients and identify factors associated with clinical remission, since knowing modifiable factors associated with remission could help achieve clinical outcomes.

Section snippets

Patients

Data was collected from 463 patients. It was an observational, retrospective, realworld cohort of patients with RA recruited at the Rheumatology division of the HUGCDN since the first of January 2000 until the thirteenth of April 2014. Inclusion criteria were patients older than 18 years, diagnosed RA according to 2010 ACR/EULAR classification criteria and with available follow-up data of a minimum of two years after the basal visit.

Results

Four hundred and sixty-three RA patients were included. Baseline characteristics of the whole cohort of patients (n = 463) are shown in Table 1. 75% of patients were female and mean age at diagnosis was 51 years. Mean disease duration was 8 years and mean follow-up time was 5.8 years. Most of the patients were positive RF and ACPA. Almost half of the patients had erosions in X-rays. The most frequent comorbidities were HTA (31%), dislypidemia (25%) and osteoporosis (14%). History of smoking was

Discussion

RA is a chronic inflammatory disease that may cause joint destruction, functional disability and a reduction of the patient's quality of life. Unfortunately, there is no curative treatment for the disease, that is why the real goal is to release inflammation to achieve remission.

Conclusion

We concluded that the initial presentation and situation of the patient and the delay in the first visit to the Rheumatologist will determine the future of the disease. The RA activity at the basal visit will be the key for the achievement of the therapeutic goals. The modifiable factors consist in improving the derivation of patients from the primary care to the specialist to make an early diagnosis and initiate an intensive treatment as soon as possible.

The present research presents various

Ethics Approval

Ethical Committee of the University Hospital of Gran Canaria Dr Negrín.

Funding

This study has not been supported by any public nor private entity.

Conflict of Interest

The authors declare no conflict of interests.

Acknowledgements

The authors would like to thank all members of the Rheumatology Department of Hospital Universitario Gran Canaria Dr Negrín.

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