Abstract
The aim of this study was to survey factors related to EULAR good response, the DAS-28 definition of remission, ACR 50 response, sustained response to tumor necrosis factor inhibitors (TNF-I) therapy in biologic naïve patients with refractory rheumatoid arthritis. This was a single center observational clinical prospective 2 years’ study, EULAR response criteria, DAS 28, HAQ and radiographic changes were recorded. Eighty patients included (64 females and 16 males, mean age was 48.4 + −17.9 years, mean disease duration 7.3 + −5.9 years). At 6 months 70% achieved EULAR good response, 51.8% achieved DAS-28 remission. Good response/sustained responses inversely correlated with baseline DAS-28 and radiographic erosions P <0.05. EULAR good response/remission by 6 months, sustained response at 2 years positively correlated with the decline in RF titers (r = 0.33, P < 0.05 & r = 0.30, P < 0.03 respectively), negatively correlated with the baseline HAQ. Regression analysis identified higher serum hemoglobin concentration, lower baseline HAQ scores, and the absence of radiographic erosions as significant predictors of good as well as sustained responses after adjustment for potential covariates. Methotrexate was associated with favorable responses and remission at 6 months (ORs = 1.13, 1.30 respectively). The study concluded that a lower baseline DAS-28 and HAQ scores, the lack of radiographic erosions favored EULAR good response and were significant predictors of sustained response to TNF-I.
Highlights
Rheumatoid Arthritis is a systemic autoimmune inflammatory disease of indefinite etiology
The aim of the current study was to prospectively survey the factors related to achieving an European League Against Rheumatism (EULAR) good/remission using the DAS-28 disease activity score and investigate predictors of a sustained response in a population of biologic naïve patients with refractory rheumatoid arthritis who receive tumor necrosis factor inhibitors Tumor necrosis factor inhibitors (TNF-I)
A total of 80 patients were included in the study 64 females (80%) and 16 males (20%), having a mean age of 48.4 + −17.91 years a mean disease duration of 7.29 + −3.93 years and a mean baseline DAS-28 of 6 ± 1, health assessment questionnaire (HAQ) of 1.25 + −0.35, mean erythrocyte sedimentation rate (ESR) of 51.00 ± 25.30 mm/hr, mean C- reactive protein (CRP) of 35.18 + −31.65 mg/l
Summary
Rheumatoid Arthritis is a systemic autoimmune inflammatory disease of indefinite etiology. The disease affects the synovial joints contributing to significant synovial inflammation, progressive joint destruction and deformity of the affected joints. RA affects approximately 1% of adults all over the world with the diagnosis usually established between the third and fifth decade of life. Within the last decade the field of therapeutics have witnessed an evolution in the Mohammed et al SpringerPlus (2015) 4:207 treatment armamentarium of rheumatoid arthritis with the lead of the Tumor necrosis factor inhibitors (TNF-I) as the first line biologic drugs (Burmester GR et al 2012; Wolfe and Michaud 2010; Nozaki et al 2013; Mohammed et al 2014; Nam et al 2010; Hetland et al 2010; Gartlehner et al 2006; Wolfe and Michaud 2010; Gaujoux-Viala et al 2010)
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