Association of age with the non-achievement of clinical and functional remission in rheumatoid arthritis

Tadashi Aoki,Hideki Ito,Yuji Nishiwaki,Ayako Hirata,Hideto Kameda,Takehisa Ogura

doi:10.1038/s41598-020-72274-2

Abstract

Patient-reported outcome (PRO) is included in the remission criteria of rheumatoid arthritis (RA). We aimed to determine the effect of age on PRO and the subsequent achievement of clinical and functional RA remission criteria. Three hundred and one patients with non-rheumatic diseases were evaluated using the 0–10 cm visual analog scale (VAS) assessment for musculoskeletal symptoms and a functional health assessment questionnaire-disability index (HAQ-DI). These assessments were compared with those obtained from 149 patients with RA with negative tender/swollen joint counts and normal serum C-reactive levels (objective clinical remission). Of the 301 patients, 32.2%, 26.6%, and 41.2% were classified as non-elderly (< 65 years), early elderly (65–74 years), and late-elderly (≥ 75 years) patients, respectively. VAS > 1 cm and HAQ-DI ≥ 0.5 were observed in 7.3% and 14.5%, respectively, in late-elderly patients, whereas ≤ 1.0% of non-elderly and early elderly patients for the both. Among 149 RA patients in objective remission, however, > 20% and > 10% of early elderly patients (and even non-elderly patients) had VAS > 1 cm and HAQ-DI ≥ 0.5, respectively, and 34.0% and 35.8% of late-elderly patients with RA had VAS > 1 cm and HAQ-DI ≥ 0.5, respectively. Multivariate logistic analysis revealed that age and RA were associated with the non-achievement of VAS ≤ 1 cm and HAQ-DI < 0.5. Therefore, the effect of age, which was independent of the presence of RA even without any objective disease activity, on PRO and the non-achievement of clinical and functional remission criteria was demonstrated.

Highlights

Patient-reported outcome (PRO) is included in the remission criteria of rheumatoid arthritis (RA)
Compared with the remaining patients with RA, those with negative joint counts and normal C-reactive protein (CRP) possessed a lower level of radiographic damage, were less frequently seropositive for rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody, and reported less usage of biologic disease-modifying antirheumatic drugs and glucocorticoids
Subjective and composite remission rates defined by patient visual analog scale (VAS) ≤ 1 cm, health assessment questionnaire-disability index (HAQ-DI) < 0.5, simplified disease activity index (SDAI) ≤ 3.3, and Boolean-based remission were greater in patients with RA with

Summary

Introduction

Patient-reported outcome (PRO) is included in the remission criteria of rheumatoid arthritis (RA). Three hundred and one patients with non-rheumatic diseases were evaluated using the 0–10 cm visual analog scale (VAS) assessment for musculoskeletal symptoms and a functional health assessment questionnaire-disability index (HAQ-DI) These assessments were compared with those obtained from 149 patients with RA with negative tender/swollen joint counts and normal serum C-reactive levels (objective clinical remission). The effect of age, which was independent of the presence of RA even without any objective disease activity, on PRO and the non-achievement of clinical and functional remission criteria was demonstrated. We conducted a cross-sectional study comparing 301 patients without defined rheumatic disease with RA patients with negative joint counts and normal serum CRP levels experiencing “objective” clinical remission to further delineate the relevance of age on PRO measures such as patient VAS and HAQ-DI scores

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