Open AccessLimiting factors to Boolean remission differ between autoantibody-positive and -negative patients in early rheumatoid arthritis
Author(s) -
Serena Bugatti,
Ludovico De Stefano,
Antonio Manzo,
Garifallia Sakellariou,
Blerina Xoxi,
Carlomaurizio Montecucco
Publication year - 2021
Publication title -
therapeutic advances in musculoskeletal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.387
H-Index - 35
eISSN - 1759-7218
pISSN - 1759-720X
DOI - 10.1177/1759720x211011826
Subject(s) - medicine , autoantibody , rheumatoid arthritis , odds ratio , methotrexate , confidence interval , complete remission , disease , gastroenterology , negativity effect , spontaneous remission , antibody , immunology , chemotherapy , pathology , psychology , social psychology , alternative medicine
Background: The patient global assessment of disease activity (PGA) is the major limiting factor to Boolean remission in patients with established rheumatoid arthritis (RA). Here, we investigated the limiting variables to disease remission in patients with early RA treated with conventional synthetic disease modifying anti-rheumatic drugs, also in relation to autoantibody status.Methods: Data were retrieved from 535 early RA patients ( 1 with the remaining three all ⩽1. Reasons for missing Boolean remission and predictors of near-remission subcategories were analyzed in relation to baseline disease variables.Results: After 6 and 12 months, near-remission was two-times more frequent than Boolean remission (25.6% and 26.9% at the two time-points). A 28-swollen joint count (SJC28) >1 was responsible for the majority of near-remission (56.2% and 57.6% at 6 and 12 months, respectively), and PGA > 1 accounted for approximatively 35% of the cases. Autoantibody-positivity independently predicted the risk of missing remission because of SJC28 > 1 [adjusted odds ratio (OR) 95% confidence interval (CI) 2.81 (1.59–4.9) at 6 months and 1.73 (1.01–3.01) at 12 months], whilst autoantibody-negativity was an independent predictor of PGA near-remission [adjusted OR (95% CI) 2.45 (1.25–4.80) at 6 months and 5.71 (2.47–13.2) at 12 months].Conclusion: In early RA, Boolean remission is more frequently missed because of persistent swollen joints. However, barriers to full-remission vary in relation to the autoantibody status. Autoantibody-positive patients more commonly experience residual swollen joints, whilst PGA more frequently impairs remission in autoantibody-negative patients. Efforts to target full-remission in early RA may thus require different strategies according to autoantibody profile.