Tight control treat-to-target approach for early rheumatoid arthritis patients to measure patient-reported outcomes

In early rheumatoid arthritis (ERA) patient, identification of prognostic factors for remission is clinically crucial and beneficial. Therefore, patient-reported outcomes (PROs) could be used as predictors of remission.

Kuusal L and colleagues conducted a randomized clinical trial involving 99 untreated ERA patients. They received a remission-targeted treatment which included three disease-modifying anti-rheumatic drugs (DMARDs) and prednisolone for 24 months along with initial six months' dose of either infliximab or placebo. The PROs measured at baseline were: 1) Eight Short Form 36 questionnaire (SF-36) dimensions, 2) Patient’s global assessment [PGA, visual analogue scale (VAS)], 3) Health Assessment Questionnaire (HAQ), and 4) Pain VAS. Multivariable-adjusted regression models were used to identify the PROs, which independently predicted modified American College of Rheumatology remission at two years.

Follow-up data at two years found in remission was 92% (93 patients), and 62% (58 patients). At baseline, patients who achieved remission got high radiological score (p = 0.04), lower tender joint count (p = 0.001), lower PGA (p = 0.005) and physician’s global assessment (p = 0.019), lower HAQ (p = 0.016), less morning stiffness (p = 0.009), and had significantly higher scores (seven out of eight SF-36 dimensions compared with patients who did not. In multivariable models that included all PROs, remission was associated with SF-36 dimension's higher vitality (odds ratio 2.01; 95% confidence interval 1.19–3.39) and better emotional role functioning (odds ratio 1.64; 95% confidence interval 1.01–2.68). Overall, PGA, pain VAS, HAQ and other SF-36 dimensions were not associated with remission.

Therefore, it was concluded that self-reported vitality and better emotional role functioning criteria were important PROs to predict the remission of ERA.