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In early arthritis patients, high HAQ at baseline and DAS28 at three months predict suboptimal outcomes at two years: a retrospective cohort study

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13

  1. Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece. afanour@med.uoa.gr
  2. Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.
  3. Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.
  4. Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.
  5. Department of Rheumatology, Hacettepe University, Ankara, Turkey.
  6. Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.
  7. Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.
  8. Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.
  9. Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.
  10. Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.
  11. Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.
  12. 4th Dept. Int. Med.,National & Kapodestrian Univ. of Athens; Joint Academic Rheumatology Program, Univ.; Inst. Molecular Biology-Biotechnology, Found. Res. & Technol.-Hellas, Voutes, Heraklion; Lab. Autoimmunity & Inflammation, Academy of Athens, Greece.
  13. Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece.

CER10759 Submission on line
2018 Vol.36, N°5 - PI 0806, PF 0813
Full Papers

Rheumatology Article

 

Abstract

OBJECTIVES:
Early arthritis clinics (EAC) aim to improve rheumatoid arthritis (RA) outcomes by tailoring treatment targeting to remission. Our aim was to analyse disease course and relevant predictors over 2 years in early arthritis; we also assessed the applicability of the “treat-to-target approach” in a real-life EAC.
METHODS:
Patients with early arthritis recruited at the EAC of the University Hospital of Heraklion were followed prospectively according to a follow-up protocol for two years, without implementing a pre-specified treatment protocol, to capture real-life practices. Early predictors of “suboptimal outcomes” (high disease activity or HAQ>1.0 at 2 years) and biologic DMARD (bDMARD) initiation were evaluated with multivariate logistic regression. Intensification of treatment at 3 and 6 months and subsequent long-term outcome were also assessed.
RESULTS:
251 patients [RA (n=188), undifferentiated arthritis (n=63)] were included. Although both DAS28 and HAQ at 2 years improved significantly compared to baseline in RA patients [mean (SD) DAS28 and median (IQR) HAQ 3.70 (1.32) and 0.44 (0.75) at 2 years, p<0.001 for both compared to baseline], 43.7% still had moderate and 18.8% high disease activity. The most powerful predictor of suboptimal outcomes or bDMARD initiation in RA was high disease activity at three months (adjusted odds ratio 2.22 and 2.62, respectively). At three and six months 72.8% and 62.4% of patients with medium/high disease activity received treatment intensification, which resulted in significant decrease in disease activity at 2 years (p<0.001 for ΔDAS28).
CONCLUSIONS:
DAS28 at three months was the most powerful predictor of suboptimal disease outcome during a 2-year follow-up in early RA. Despite significant DAS reductions, more than 50% of patients have active disease at two years. Failure to fully implement the treat-to-target strategy in our cohort could account for the low remission rates.

PMID: 29533750 [PubMed]

Received: 21/08/2017 - Accepted : 22/01/2018 - In Press: 28/02/2018 - Published: 26/09/2018