Abstract
IntroductionTo investigate the course of functional status assessed by health assessment questionnaire (HAQ) in rheumatoid arthritis (RA) patients with sustained clinical remission (REM).MethodsIn recent RA clinical trials, we identified patients with subsequent visits of ≥24 weeks in clinical REM according to the disease activity score using 28-joint counts including C-reactive protein (DAS28) (≤2.6), or simplified disease activity index (SDAI) (≤3.3). Area under the curve (AUC) and mean HAQ scores throughout the time in sustained REM were compared using t test, analyses of variance (ANOVA) and adjusted general linear modeling (GLM) with repeated measures. In Cox regression analyses, the time to regain full physical function was modeled. Sensitivity analyses were performed in patients of sustained SDAI low disease activity (LDA; SDAI ≤11).ResultsA total of 610 out of 4364 patients achieved sustained DAS28 REM (14 %) and 252 SDAI REM (5.8 %). ANOVA testing for linear trend showed significant decrease of mean HAQ from week 0 (start of REM) to week 24, regardless of REM criteria used. AUC of HAQ throughout 24 weeks of REM was higher in DAS28 compared to SDAI REM (p ≤0.01). GLM adjusting for covariates showed significant decrease of monthly HAQ scores from week 0 to 24 (DAS28: 0.276, 0.243, 0.229, 0.222, 0.219, 0.209 to 0.199; p = 0.0001; SDAI: 0.147, 0.142, 0.149, 0.129, 0.123, 0.117 to 0.114; p = 0.029). Similarly, a decrease of HAQ over time was found in patients of sustained SDAI LDA. In DAS28 REM, the chance of regaining full physical function was higher for female (hazard ratio HR [95 % confidence interval]: 1.41 [1.13–1.76]) and early RA patients (disease duration ≤2 years: HR 1.29 [1.01–1.65]); in SDAI REM no significant differences were found.ConclusionsPhysical function continues to improve if the target of REM or LDA is sustained. The stringency of the remission criteria determines achievement of the best possible functional improvement.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0719-x) contains supplementary material, which is available to authorized users.
Highlights
To investigate the course of functional status assessed by health assessment questionnaire (HAQ) in rheumatoid arthritis (RA) patients with sustained clinical remission (REM)
To adjust for factors associated with physical function, we extended analyses of variance (ANOVA) to general linear models (GLM) with repeated measures, using HAQ as dependent variable
Adjusted analyses of the course of physical function in sustained remission After adjusting for covariates in general linear modeling (GLM) repeated measures, we found a significant change of HAQ scores over time in patients with sustained DAS28 REM (p = 0.02)
Summary
To investigate the course of functional status assessed by health assessment questionnaire (HAQ) in rheumatoid arthritis (RA) patients with sustained clinical remission (REM). The introduction of new treatment strategies including synthetic and biological agents has facilitated effective management of rheumatoid arthritis (RA), leading to better outcomes than seen in earlier years [1,2,3,4,5]. Clinical remission (REM) has become a widely accepted treatment goal, at least in patients with early disease, because patients in REM show higher quality of life, better physical function and work capacity, even when compared to low disease activity [6, 7]. Even more relevant than inhibiting structural damage is the prevention of persistent functional disability in patients with RA.
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