Rocio V Gamboa-Cárdenas1, Manuel F Ugarte-Gil2,3, Massardo Loreto4, Mónica P Sacnun5, Verónica Saurit6, Mario H Cardiel7, Enrique R Soriano8, Cecilia Pisoni9, Claudio M Galarza-Maldonado10, Carlos Rios11, Sebastião C Radominski12, Geraldo da R Castelar-Pinheiro13, Washington Alves Bianchi14, Simone Appenzeller15, Inés Guimarães da Silveira16, Cristiano A de Freitas Zerbini17, Carlo V Caballero-Uribe18, Adriana Rojas-Villarraga19, Marlene Guibert-Toledano20, Francisco Ballesteros21, Rubén Montufar22, Janitzia Vázquez-Mellado23, Jorge Esquivel-Valerio24, Ignacio García De La Torre25, Leonor A Barile-Fabris26, Fedra Irazoque Palezuelos27, Lilia Andrade-Ortega27, Pablo Monge28, Raquel Teijeiro29, Ángel F Achurra-Castillo30, María H Esteva Spinetti31, Graciela S Alarcón32, Bernardo A Pons-Estel5,33. 1. Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Av. Miguel Grau 800, La Victoria, 15033, Lima, Peru. rvgc1@yahoo.com. 2. Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Av. Miguel Grau 800, La Victoria, 15033, Lima, Peru. 3. Universidad Científica del Sur, Lima, Peru. 4. Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile. 5. Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina. 6. Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina. 7. Centro de Investigación Clínica de Morelia, Morelia, Mexico. 8. Sección Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 9. Sección de Inmunología y Reumatología, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina. 10. Unidad de Enfermedades Reumáticas y Autoinmunes (UNERA), Corporación Médica Monte Sinaí, Cuenca, Ecuador. 11. Centro de Reumatología y Rehabilitación, Universidad Espíritu Santo, Guayaquil, Ecuador. 12. Serviço de Reumatologia, Hospital de Clinicas da Universidade Federal do Paraná, Curitiba, Brazil. 13. Disciplina de Reumatologia, Departamento de Medicina Interna, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. 14. Serviço de Reumatologia do Hospital General da Santa Casa da Misericórdia do Rio de Janeiro, Faculdade de Medicina da Universidade Estácio de Sá, Departamento de Medicina Interna da Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. 15. Rheumatology Unit School of Medical Science, University of Campinas, Campinas, Brazil. 16. Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. 17. Centro Paulista de Investigación Clínica, São Paulo, Brazil. 18. Servicio de Reumatología, Hospital Universidad del Norte, Barranquilla, Colombia. 19. Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia. 20. Servicio de Reumatología, Hospital Clínico Quirúrgico Diez de Octubre, Havana, Cuba. 21. Servicio de Reumatología, Hospital Clínico San Borja-Arriaran, Santiago de Chile, Chile. 22. Departamento de Reumatología, Consultorio de Especialidades del Instituto Salvadoreño de Seguro Social, San Salvador, El Salvador. 23. Servicio de Reumatología, Hospital General de México, Ciudad de México, Mexico. 24. Servicio de Reumatología, Hospital Universitario "Dr. José Eleuterio Gonzalez", Monterrey, Mexico. 25. Departamento de Inmunología y Reumatología, Hospital General de Occidente, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico. 26. Servicio de Reumatología, Hospital Ángeles del Pedregal, Ciudad de México, Mexico. 27. Servicio de Reumatología, Centro Médico Nacional 20 de Noviembre, Ciudad de México, Mexico. 28. Hospital México, Caja Costarricense de Seguro Social, Universidad de Costa Rica, San José, Costa Rica. 29. Médica Uruguaya Corporación de Asistencia Médica (MUCAM), Montevideo, Uruguay. 30. Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid, Caja de Seguro Social de Panamá, Panama City, Panama. 31. Servicio de Reumatología, Departamento de Medicina, Hospital Central de San Cristóbal, San Cristóbal, Venezuela. 32. Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA. 33. Departamento de Medicina Interna, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño, Rosario, Argentina.
Abstract
OBJECTIVES: To identify baseline predictors of remission and low disease activity (LDA) in early rheumatoid arthritis (RA) from the GLADAR (Grupo Latino Americano De estudio de la Artritis Reumatoide) cohort. METHODS: Patients with 1- and 2-year follow-up visits were included. Remission and LDA were defined by DAS28-ESR (< 2.6 and ≤ 3.2, respectively). Baseline predictors examined were gender, ethnicity, age at diagnosis, socioeconomic status, symptoms' duration, DMARDs, RF, thrombocytosis, anemia, morning stiffness, DAS28-ESR (and its components), HAQ-DI, DMARDs and corticosteroid use, and Sharp-VDH score. Multivariable binary logistic regression models (excluding DAS28-ESR components to avoid over adjustment) were derived using a backward selection method (α-level set at 0.05). RESULTS: Four hundred ninety-eight patients were included. Remission and LDA/remission were met by 19.3% and 32.5% at the 1-year visit, respectively. For the 280 patients followed for 2 years, these outcomes were met by 24.3% and 38.9%, respectively. Predictors of remission at 1 year were a lower DAS28-ESR (OR 1.17; CI 1.07-1.27; p = 0.001) and HAQ-DI (OR 1.48; CI 1.04-2.10; p = 0.028). At 2 years, only DAS28-ESR (OR 1.40; CI 1.17-1.6; p < 0.001) was a predictor. Predictors of LDA/remission at 1 year were DAS28-ESR (OR 1.42; CI 1.26-1.61; p < 0.001), non-use of corticosteroid (OR 1.74; CI 1.11-2.44; p = 0.008), and male gender (OR 1.77; CI 1.2-2.63; p = 0.036). A lower baseline DAS28-ESR (OR 1.45; CI 1.23-1.70; p < 0.001) was the only predictor of LDA/remission at 2 years. CONCLUSIONS: A lower disease activity consistently predicted remission and LDA/remission at 1 and 2 years of follow-up in early RA patients from the GLADAR cohort. Key Points • In patients with early RA, a lower disease activity at first visit is a strong clinical predictor of achieving remission and LDA subsequently. • Other clinical predictors of remission and LDA to keep in mind in these patients are male gender, non-use of corticosteroids and low disability at baseline. • Not using corticosteroids at first visit is associated with a lower disease activity and predicts LDA/remission at 1 year in these patients.
OBJECTIVES: To identify baseline predictors of remission and low disease activity (LDA) in early rheumatoid arthritis (RA) from the GLADAR (Grupo Latino Americano De estudio de la Artritis Reumatoide) cohort. METHODS:Patients with 1- and 2-year follow-up visits were included. Remission and LDA were defined by DAS28-ESR (< 2.6 and ≤ 3.2, respectively). Baseline predictors examined were gender, ethnicity, age at diagnosis, socioeconomic status, symptoms' duration, DMARDs, RF, thrombocytosis, anemia, morning stiffness, DAS28-ESR (and its components), HAQ-DI, DMARDs and corticosteroid use, and Sharp-VDH score. Multivariable binary logistic regression models (excluding DAS28-ESR components to avoid over adjustment) were derived using a backward selection method (α-level set at 0.05). RESULTS: Four hundred ninety-eight patients were included. Remission and LDA/remission were met by 19.3% and 32.5% at the 1-year visit, respectively. For the 280 patients followed for 2 years, these outcomes were met by 24.3% and 38.9%, respectively. Predictors of remission at 1 year were a lower DAS28-ESR (OR 1.17; CI 1.07-1.27; p = 0.001) and HAQ-DI (OR 1.48; CI 1.04-2.10; p = 0.028). At 2 years, only DAS28-ESR (OR 1.40; CI 1.17-1.6; p < 0.001) was a predictor. Predictors of LDA/remission at 1 year were DAS28-ESR (OR 1.42; CI 1.26-1.61; p < 0.001), non-use of corticosteroid (OR 1.74; CI 1.11-2.44; p = 0.008), and male gender (OR 1.77; CI 1.2-2.63; p = 0.036). A lower baseline DAS28-ESR (OR 1.45; CI 1.23-1.70; p < 0.001) was the only predictor of LDA/remission at 2 years. CONCLUSIONS: A lower disease activity consistently predicted remission and LDA/remission at 1 and 2 years of follow-up in early RApatients from the GLADAR cohort. Key Points • In patients with early RA, a lower disease activity at first visit is a strong clinical predictor of achieving remission and LDA subsequently. • Other clinical predictors of remission and LDA to keep in mind in these patients are male gender, non-use of corticosteroids and low disability at baseline. • Not using corticosteroids at first visit is associated with a lower disease activity and predicts LDA/remission at 1 year in these patients.
Entities:
Keywords:
Early RA outcomes; Early RA remission; Early RA response predictors; Latin America early RA
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