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Prevalence and predictors of long-term remission in rheumatoid arthritis in real-world practice: a longitudinal study

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Abstract

Objectives

The aim of the present study was to provide real-world evidence for factors predicting long-term remission in a longitudinal study of rheumatoid arthritis (RA) patients.

Methods

Long-term remission was defined by meeting American Rheumatism Association (ARA) criteria for remission and prednisolone dose ≤ 5 mg/d for at least 5 years. Patients in this cohort were treated by tight control strategy using step-up combination therapy with conventional synthetic DMARDs (csDMARDs), biologic DMARDs. The parameters associated with long-term remission were subjected to univariate analysis, and parameters with P-values of < 0.1 in univariate analysis were included in a multivariate regression analysis.

Results

One thousand two hundred and eighty-six RA subjects were considered for eligibility, and finally, 499 patients were included in the study. Median duration of follow-up was 108 months. Long-term remission occurred in 157 (31.5%) patients. Median time to long-term remission was 8 (5, 41) months. Predictors of long-term remission were absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset > 60, being anti-citrullinated protein antibodies (ACPA) negative, and Disease Activity Score-28 (DAS28) at cohort entry ≤ 5.1.

Conclusion

In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy. Absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset > 60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission.

Key Points

• In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy.

• Median time to long-term remission was 8 months.

• Absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset >60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission.

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Data Availability

The data that support the findings of this study are not openly available due to [reasons of sensitivity e.g. human data] and are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to appreciate the cooperation of the Clinical Research Development Unit of Imam Reza General Hospital, Tabriz, Iran in conducting this research. We also thank all the patients for participating in this study.

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Authors and Affiliations

  1. Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St., P.O Box 5166614756, Tabriz, Iran

    Alireza Khabbazi, Leyla Gadakchi, Mohammadreza Moslemi, Amirreza Khalaji, Mehrzad Hajialilo & Aida Malek Mahdavi

  2. Internal Medicine Department, Kashan University of Medical Sciences, Kashan, Iran

    Kamal Esalatmanesh & Asma Ziarati Yazdeli

  3. Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Aida Malek Mahdavi

  4. Rahat Breathe and Sleep Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Aida Malek Mahdavi

Authors
  1. Alireza Khabbazi
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Contributions

AKH, KE, and AMM designed the study; AKH, LG, MM, AKH, KE, AZY, and MH were involved in data acquisition and/or management; AKH and KE analyzed the data and critically interpreted the results; AKH, LG, KE, and AMM were involved in drafting the manuscript. All authors revised the manuscript critically for important intellectual content and approved the final manuscript.

Corresponding author

Correspondence to Aida Malek Mahdavi.

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The study was performed in compliance with ethical standards.

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Khabbazi, A., Gadakchi, L., Moslemi, M. et al. Prevalence and predictors of long-term remission in rheumatoid arthritis in real-world practice: a longitudinal study. Clin Rheumatol 42, 1537–1544 (2023). https://doi.org/10.1007/s10067-023-06548-1

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