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Early remission is associated with improved survival in patients with inflammatory polyarthritis: results from the Norfolk Arthritis Register.
- Source :
-
Annals of the rheumatic diseases [Ann Rheum Dis] 2014 Sep; Vol. 73 (9), pp. 1677-82. Date of Electronic Publication: 2013 Jun 07. - Publication Year :
- 2014
-
Abstract
- Objectives: This study aimed to evaluate whether the early achievement of clinical remission influences overall survival in an inception cohort of patients with inflammatory polyarthritis (IP).<br />Methods: Consecutive early IP patients, recruited to a primary care based inception cohort from 1990 to 1994 and from 2000 to 2004 were eligible for this study. Remission was defined as absence of clinically detectable joint inflammation on a 51-joint count. In sensitivity analyses, less stringent definitions of remission were used, based on 28-joint counts. Remission was assessed at 1, 2 and 3 years after baseline. All patients were flagged with the national death register. Censoring was set at 1 May 2011. The effect of remission on mortality was analysed using the Cox proportional hazard regression model, and presented as HRs and 95% CIs.<br />Results: A total of 1251 patients were included in the analyses. Having been in remission at least once within the first 3 years of follow-up was associated with a significantly lower risk of death: HR 0.72 (95% CI 0.55 to 0.94). Patients who were in remission 1 year after the baseline assessments and had persistent remission over time had the greatest reduction in mortality risk compared with patients who never achieved remission within the first 3 years of follow-up: HR 0.58 (95% CI 0.37 to 0.91). Remission according to less stringent definitions was associated with progressively lower protective effect.<br />Conclusions: Early and sustained remission is associated with decreased all-cause mortality in patients with IP. This result supports clinical remission as the target in the management of IP.<br /> (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Subjects :
- Adult
Aged
Antirheumatic Agents therapeutic use
England epidemiology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Primary Health Care
Prognosis
Registries
Remission Induction
Severity of Illness Index
Terminology as Topic
Time Factors
Treatment Outcome
Arthritis drug therapy
Arthritis mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1468-2060
- Volume :
- 73
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Annals of the rheumatic diseases
- Publication Type :
- Academic Journal
- Accession number :
- 23749581
- Full Text :
- https://doi.org/10.1136/annrheumdis-2013-203339