Scott, IC, Fowzia, I, Panayi, G, Cope, AP, Garrood, T, Vincent, A, Scott, DL and Kirkham, B (2018) The Frequency of Remission and Low Disease Activity in Patients with Rheumatoid Arthritis, and their Ability to Identify People with Low Disability and Normal Quality Of Life. Seminars in Arthritis and Rheumatism.

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Abstract

Objective
Treat-to-target in rheumatoid arthritis (RA) recommends targeting remission, with low disease activity (LDA) being an alternative goal. When deciding to target remission or LDA, important considerations are the likelihood of attaining them, and their impacts on function and healthrelated quality of life (HRQoL). We have addressed this by studying: (a) the frequency of remission and LDA/remission; (b) DAS28-ESR trends after remission; (c) ability of remission vs. LDA to identify patients with normal function (HAQ ≤0.5) and HRQoL (EQ-5D ≥ the normal population).

Methods
We studied 571 patients in two clinical trials, and 1,693 patients in a 10-year routine care cohort. We assessed the frequency and sustainability of remission and LDA/remission, variability in DAS28-ESR after remission, and sensitivity/specificity of remission and LDA/remission at identifying patients with low disability levels and normal HRQoL using Receiver Operator Characteristic (ROC) curves.

Results
Point remission and remission/LDA were common (achieved by 35-58% and 49-74% of patients, respectively), but were rarely sustained (sustained remission and remission/LDA achieved by 5-9% and 9-16% of patients, respectively). Following attaining remission, DAS28-ESR levels varied substantially. Despite this, of those patients attaining point remission, the majority (53-61%) were in remission at study end-points. Whilst remission was highly specific at identifying patients with low disability (85-91%) it lacked sensitivity (51-57%); similar findings were seen for normal HRQoL (specificity 78-86%; sensitivity 52-59%). The optimal DAS28-cut-off to identify individuals with low disability and normal HRQoL was around the LDA threshold.

Conclusions
Our findings support both the treat-to-target goals. Attaining remission is highly specific for attaining low disability and normal HRQoL, although many patients with more active disease also have good function and HRQoL. Attaining a DAS28-ESR ≤3.2 has a better balance of specificity and sensitivity for attaining these outcomes, with the benefit of being more readily achievable. Although sustaining these targets over time is rare, even attaining them on a oneoff basis leads to better function and HRQoL outcomes for patients.

Item Type: Article
Additional Information: The final published version of this accepted article will be available at https://www.journals.elsevier.com/seminars-in-arthritis-and-rheumatism
Uncontrolled Keywords: Rheumatoid Arthritis, treatment targets, health-related quality of life, function
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 04 Jan 2019 10:00
Last Modified: 25 Feb 2019 10:05
URI: http://eprints.keele.ac.uk/id/eprint/5630

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