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5. Defining remission in rheumatoid arthritis: does it matter to the patient? A comparison of multi-dimensional remission criteria and patient reported outcomes.

Author

Gul, Hanna L, Eugenio, Gisella, Rabin, Thibault, Burska, Agata, Parmar, Rekha, Wu, Jianhua, Ponchel, Frederique, and Emery, Paul

Subjects
*RHEUMATOID arthritis treatment, *DOPPLER ultrasonography, *ANTIRHEUMATIC agents, *C-reactive protein, *INFLAMMATION, *HEALTH outcome assessment, *QUALITY of life, *T cells, *DISEASE remission, *CROSS-sectional method, *DESCRIPTIVE statistics
Abstract

Objectives In a cross-sectional study, we evaluated the prevalence of 'multi-dimensional remission' (MDR) and its component parameters, assessed using objective measures in a cohort of RA patients in treatment-induced DAS28-remission, and their relationship with patient-reported outcome measures. We sought to confirm the feasibility and face validity of the MDR construct, providing a platform for future longitudinal studies in which its clinical utility might be further established. Methods 605 patients were selected from an inflammatory arthritis register using DAS28(CRP)<2.6. Demographic, clinical and patients reported outcomes (PRO) data were collected. Ultrasound power doppler synovitis (n = 364) and T-cell subsets (n = 297) were also measured. Remission using clinical parameters was defined as: tender and swollen joint count (TJC/SJC) and CRP all ⩽1; ultrasound remission: total power doppler = 0 and T cell remission: positive normalized naïve T-cell frequency. MDR was defined as the achievement of all three dimensions. Results Overall, only 53% (321/605) of the patients achieved clinical parameters, failures being mainly due to raised CRP (52%), TJC (28)>1 (37%) or SJC (28)>1 (16%). 211/364 (58%) of patients achieved ultrasound remission and 193/297 (65%) patients showed T-cell remission. Complete data were available for 231 patients. MDR was observed in only 35% and was associated with the best (lower) PRO scores (all P ⩽ 0.05 vs non-MDR) when compared with the other definitions of remission assessed. The MDR rate was similar in early and established RA patients on b-DMARDs; however, it was lower in established RA patients who received multiple cs-DMARDs (P = 0.011). Conclusions In this study, MDR, which may represent a state closer to normality, was found to occur in about a third of DAS28-remission patients and was associated with better patient-reported outcome measures. MDR could be a novel optimal treatment target, notably from a patient's perspective. The relevance of these findings needs further assessment. [ABSTRACT FROM AUTHOR]

Published
2020
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8. Effect of Fatigue, Older Age, Higher Body Mass Index, and Female Sex on Disability in Early Rheumatoid Arthritis in the Treatment‐to‐Target Era

Author

Twigg, Sarah, Hensor, Elizabeth M. A., Freeston, Jane, Tan, Ai Lyn, Emery, Paul, Tennant, Alan, Morgan, Ann W., Conaghan, Philip, Keenan, Anne‐Maree, Hensor, Elizabeth, Quinn, Mark, Gough, Andrew, Green, Michael, Reece, Richard, Hordon, Lesley, Helliwell, Philip, Melsom, Richard, Doherty, Sheelagh, Adebajo, Ade, Harvey, Andrew, Jarrett, Steve, Huston, Gareth, Isdale, Amanda, Martin, Mike, Karim, Zunaid, McGonagle, Dennis, Pease, Colin, Cox, Sally, Bejarano, Victoria, Nam, Jackie, Villeneuve, Edith, Brown, Claire, Thomas, Christine, Pickles, David, Hammond, Alison, Neville, Beverley, Fairclough, Alan, Nunns, Caroline, Gill, Anne, Green, Julie, Rhys‐Evans, Belinda, Padwell, Barbara, Madden, Julie, Taylor, Lynda, Smith, Sally, King, Heather, Firth, Jill, Heard, Jayne, Sigsworth, Linda, Corscadden, Diane, Henshaw, Karen, Rashid, Lubna‐Haroon, Martin, Stephen, Robinson, James, Kozera, Lukasz, Burksa, Agata, Fahy, Sarah, Paterson, Andrea, Hensor, Elizabeth, Ponchel, Frederique, Buch, Maya, Nam, Jackie, Villeneuve, Edith, Conaghan, Philip, Andrews, Jacqueline, Wakefield, Richard, McGonagle, Denis, Marzo‐Ortega, Helena, Das, Sudipto, Horton, Sarah, Mackie, Sarah, Thomas, Rebecca, Bissell, Lesley Ann, Rakieh, Chadi, Ash, Zoe, Aslam, Amir, Saleem, Benazir, Coates, Laura, Fazal, Fahad, Hunt, Laura, Vital, Ed, Ferguson, Esme, Else, Sara, Tran, Gui, Zayat, Ahmed, Abignano, Guiseppina, Yousef, Yuz, Raghunath, Radhika, Mathieson, Hannah, Ramakumain, Chitra, Gul, Hanna, Mahmood, Mahwish, Fitzgerald, Pauline, Robinson, Matthew, Ward, Jason, Wells, Beverly, Pickles, David, Wordsworth, Oliver, Thomas, Christine, McManus, Alison, Bailey, Lynda, Gray, Linda, Fitzgerald, Pauline, Russell, Kate, Davies, Jayne, Corscadden, Diane, Henshaw, Karen, Rashid, Lubna‐Haroon, Martin, Stephen, Robinson, James, Kozera, Lukasz, Burksa, Agata, Mbara, Katie, Fahy, Sarah, Halsted‐Rastrick, Jill, Connoly‐Thompson, Ged, Thompson, Jonathan, Weatherill, Ian, Paterson, Andrea, Horton, Laura, Jackson, Alwyn, and Hodgson, Richard

Abstract

To compare disease activity and disability over 2 years in early rheumatoid arthritis (RA) before and after implementation of treat‐to‐target therapy and identify predictors of adverse outcome. The Yorkshire Early Arthritis Register (YEAR) recruited 725 patients with early RAbetween 2002 and 2009, treated with a step‐up approach. The Inflammatory Arthritis Continuum study (IACON) recruited cases between 2010 and 2014 and treated to target. A total of 384 IACONcases met 2010 American College of Rheumatology/European League Against Rheumatism criteria. Latent growth curves of change in Disease Activity Score in 28 joints (DAS28) and the Health Assessment Questionnaire (HAQ) were compared between YEARand IACON. Latent class growth analysis identified trajectories of change. Baseline predictors of trajectories were identified using logistic regression. The mean DAS28 over 2 years was lower in IACONthan in YEAR. Latent trajectories of HAQchange in YEARwere high stable (21% of cohort), moderate reducing (35%), and low reducing (44%). Only moderate reducing (66%) and low reducing (34%) were seen in IACON. In both cohorts, female sex and fatigue predicted adverse HAQtrajectories (high stable and moderate reducing). Odds ratios (ORs) for moderate reducing compared to low reducing for women were 2.58 (95% confidence interval [95% CI] 1.69, 4.49) in YEARand 5.81 (95% CI2.44, 14.29) in IACON. ORs per centimeter fatigue visual analog score were 1.13 (95% CI1.07, 1.20) in YEARand 1.16 (95% CI1.12, 1.20) in IACON. Treat‐to‐target therapy gave more favorable trajectories of change in DAS28 and HAQ, but adverse HAQtrajectory was more likely in women with greater fatigue, suggesting such patients would benefit from interventions to improve function as well as reduce inflammation.

Published
2018
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9. Treating rheumatoid arthritis to an imaging target produces better outcomes, or does it?

Author

Mankia, Kulveer, Gul, Hanna, and Emery, Paul

Subjects
*RHEUMATOID arthritis treatment, *DIAGNOSTIC imaging, *JOINT diseases, *MAGNETIC resonance imaging, *SERIAL publications, *TREATMENT effectiveness, *DISEASE remission, *DISEASE progression
Abstract

The authors reflect on the predictors of joint damage progression and stringent remission in patients with rheumatoid arthritis (RA) and the RA treatments. Other topics include the use of targeted ultrasound (US) techniques to monitor remission, and the effectiveness of magnetic resonance imaging (MRI) tenosynovitis and osteitis in predicting erosion progression.

Published
2021
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