Physician global assessment at 3 months is strongly predictive of remission at 12 months in early rheumatoid arthritis: results from the CATCH cohort

Rheumatology (Oxford). 2014 Mar;53(3):482-90. doi: 10.1093/rheumatology/ket366. Epub 2013 Nov 15.

Abstract

Objective: The objective of this study was to determine predictors of 1-year remission in early RA (ERA) using baseline and 3-month data.

Methods: The Canadian Early Arthritis Cohort (CATCH) patients were included if baseline, 3- and 12-month data were available. Regression analyses for four different definitions of remission at 12 months were done to determine baseline and 3-month predictors of remission.

Results: Five hundred and sixty-two patients had complete data at 12 months (mean age 53.4 years, disease duration 6.2 years, 73% female). The factors at baseline associated with all four remission outcomes at 12 months were age, gender, income, education, tender joint count (TJC), patient global assessment (PtGA), HAQ and pain. Baseline ESR was associated with the 28-joint DAS (DAS28) remission only. At 3 months, all four remission definitions were associated with TJC, swollen joint count, physician global assessment (PGA), PtGA, HAQ, pain, ESR and CRP in univariate analyses. In the regression model, variables associated with Simple Disease Activity Index remission were PGA [odds ratio (OR) 0.77, P < 0.001), pain (OR 0.85, P = 0.004), age (OR 0.98, P = 0.006) and HAQ (OR 0.49, P = 0.011); Clinical Disease Activity Index remission was associated with PGA (OR 0.77, P < 0.001), pain (OR 0.85, P = 0.003), age (OR 0.98, P = 0.015) and CRP (OR 0.80, P = 0.031). DAS28 remission was predicted by ESR (OR 0.95, P < 0.001), PGA (OR 0.76, P < 0.001), age (OR 0.98, P = 0.001), HAQ (OR 0.57, P = 0.006) and male gender (OR 2.01, P = 0.005), whereas Boolean remission was associated with pain (OR 0.79, P = 0.009), age (OR 0.98, P = 0.016), PtGA (OR 0.83, P = 0.025) and PGA (OR 0.86, P = 0.038).

Conclusion: A low PGA at 3 months was consistently associated with 1-year remission in ERA.

Keywords: CATCH cohort; DAS; DMARDs; ERA; SJC; physician global assessment.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / blood
  • Arthritis, Rheumatoid / diagnosis
  • Arthritis, Rheumatoid / drug therapy*
  • Biological Products / therapeutic use*
  • Blood Sedimentation
  • C-Reactive Protein / metabolism
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Glucocorticoids / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Ontario
  • Pain Measurement / methods*
  • Patient Outcome Assessment*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Regression Analysis
  • Remission Induction
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Antirheumatic Agents
  • Biological Products
  • Glucocorticoids
  • C-Reactive Protein