NEW YORK (Reuters Health)—Obesity in women and current smoking in men appear to be the strongest predictors of lack of remission in early rheumatoid arthritis (RA) within one year, according to new research presented June 13 at EULAR 2018, the annual meeting of the European League Against Rheumatism, in Amsterdam.1
Even though early identification and aggressive treatment of RA improves outcomes, 46% of women and 38% of men with early RA who received guideline-based care did not reach remission within one year, the authors wrote in their abstract.
“There has never been a better time to have RA, as effective treatments are available that enable people to remain independent and continue to live full meaningful lives. For example, an athlete in the 2018 Winter Olympics, snowboarder Spencer O’Brien, has RA,” lead author Dr. Susan J. Bartlett of Johns Hopkins University, Baltimore, and McGill University, Montreal, Canada, tells Reuters Health.
“The goal of treatment is to bring RA inflammation under remission quickly. Unfortunately, evidence suggests that up to 40% of people with newly diagnosed RA continue to have active disease one year later,” Dr. Bartlett, who presented the study, says by email.
“Our results suggest that lifestyle changes—smoking cessation in men and weight reduction in women—as well as optimizing methotrexate use may facilitate rapid reduction of inflammation, an essential goal of treatment in early RA,” she writes in a press release.
Dr. Bartlett and her colleagues compared predictors of persistent low, moderate and high disease activity in 1,628 men and women in the first year of treatment for early RA. Participants were enrolled in the Canadian Early Arthritis Cohort (CATCH) from 2007 to 2016 and were receiving guideline-based care. Overall, 72% were female, the average age was 55, the average number of comorbidities was two and the average symptom duration as six months.
Participants had active disease at baseline and were followed-up for at least 12 months. They underwent clinical assessments, questionnaires, and lab tests.
The authors used logistic regression with backward selection to identify predictors of failing to achieve remission, with a 28-joint disease activity score (DAS28) <2.6 by 12 months.
On multivariable analysis, obesity more than doubled the likelihood of not reaching remission in women. Other predictors were minority status, less education, as well as higher tender joint counts and fatigue scores at baseline. In men, current smoking was linked with a 3.5 greater likelihood of not reaching remission by 12 months. Other predictors included older age and greater pain.