Earlier time to remission predicts sustained clinical remission in early rheumatoid arthritis--results from the Canadian Early Arthritis Cohort (CATCH)

Bindee Kuriya; Juan Xiong; Gilles Boire; Boulos Haraoui; Carol Hitchon; Janet Pope; John Carter Thorne; Diane Tin; Edward C Keystone; Vivian Bykerk; CATCH Investigators

doi:10.3899/jrheum.140137

Earlier time to remission predicts sustained clinical remission in early rheumatoid arthritis--results from the Canadian Early Arthritis Cohort (CATCH)

J Rheumatol. 2014 Nov;41(11):2161-6. doi: 10.3899/jrheum.140137. Epub 2014 Oct 1.

Collaborators

Affiliations

¹ From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University. bkuriya@mtsinai.on.ca.
² From the Rheumatology Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; Rheumatology Department, St. Joseph's Health Care, Western University, London; Southlake Regional Health Centre, Newmarket, Ontario, Canada; Hospital for Special Surgery, Cornell University, New York, New York, USA.B. Kuriya, MD, MS, FRCPC; J. Xiong, MSc, PhD, Rheumatology Department, Mount Sinai Hospital, University of Toronto; G. Boire, MD, MSc, FRCPC, Université de Sherbrooke; B. Haraoui, MD, FRCPC, Rheumatic Disease Unit, Institut de Rhumatologie; C. Hitchon, MD, MSc, FRCPC, Arthritis Centre, University of Manitoba; J. Pope, MD, MPH, FRCPC, Rheumatology Department, St. Joseph's Health Care, Western University; J.C. Thorne, MD, FRCP, FACP; D. Tin, BSc PHm, RPh, CDE, CGP, Southlake Regional Health Centre; E.C. Keystone, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto; V. Bykerk, MD, FRCPC, Rheumatology Department, Mount Sinai Hospital, University of Toronto, and Hospital for Special Surgery, Cornell University.

PMID: 25274902
DOI: 10.3899/jrheum.140137

Abstract

Objective: To evaluate the prevalence and predictive factors of sustained remission in an early rheumatoid arthritis (ERA) population. Predictive factors of sustained remission in ERA are unknown. We hypothesized that a short time to remission is an important predictor of sustained clinical remission.

Methods: Patients in the Canadian Early Arthritis Cohort were included. Remission was defined by Boolean-based American College of Rheumatology/European League Against Rheumatism clinical trial and clinical practice definitions and Simplified Disease Activity Index (SDAI). Logistic regression analysis identified predictors of sustained remission and influence of time to remission.

Results: Of 1840 patients, 633 (34%) achieved clinical trial remission, 759 (41%) clinical practice remission, and 727 (39%) SDAI remission. Over half of those meeting remission criteria achieved sustained remission based on clinical trial (55%), clinical practice (60%), and/or SDAI (58%). Corticosteroid use and lack of initial disease-modifying antirheumatic drug (DMARD) were associated with decreased probability of sustained remission, while initial combination DMARD increased this probability. Female sex, greater pain, and longer time to first remission made sustained remission less likely.

Conclusion: Female sex, greater pain, and lack of initial DMARD therapy reduced the probability of sustained remission. A shorter time to remission is related to sustainability and supports striving for early remission.

Keywords: DISEASE-MODIFYING ANTIRHEUMATIC DRUGS; OUTCOMES; REMISSION; RHEUMATOID ARTHRITIS.

Publication types

Clinical Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Age Factors
Aged
Antirheumatic Agents / therapeutic use*
Arthritis, Rheumatoid / diagnosis*
Arthritis, Rheumatoid / drug therapy*
Canada
Cohort Studies
Databases, Factual
Early Diagnosis
Female
Follow-Up Studies
Humans
Male
Middle Aged
Multivariate Analysis
Pain Measurement*
Predictive Value of Tests
Prospective Studies
Range of Motion, Articular / physiology*
Remission Induction
Risk Assessment
Severity of Illness Index
Sex Factors
Time Factors
Treatment Outcome

Substances

Antirheumatic Agents