• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. Jun 2004; 63(6): 675–680.
PMCID: PMC1755028

Prognostic factors for remission in early rheumatoid arthritis: a multiparameter prospective study

Abstract

Objective: To determine prognostic factors for remission in early rheumatoid arthritis.

Methods: 191 patients with rheumatoid arthritis whose disease duration was less than one year were followed up prospectively for five years. Remission, defined by a disease activity score (DAS) of <1.6, was used as the outcome measure. Baseline clinical, laboratory, genetic, and radiographic data (with radiographic scores determined by Sharp's method, modified by van der Heijde) were obtained.

Results: 48 patients (25.1%) fulfilled the remission criteria at the three year follow up visit, and 30 (15.7%) at three and five years. On univariate analysis by Fisher's exact test, remission at three years and persistent remission at five years were closely correlated with baseline DAS values, C reactive protein level, Ritchie score, health assessment questionnaire score, duration of morning stiffness, and to a lesser extent baseline total radiological scores and rheumatoid factor negativity. No significant correlation was found with sex, age, extra-articular manifestations, erythrocyte sedimentation rate, anti-cyclic citrullinated protein antibodies, anti-keratin antibodies, anti-HSP 90, anticalpastatin antibodies, antinuclear antibodies, or HLA-DRB1* genotypes. Logistic regression analysis showed that the baseline independent variables predictive of remission were low DAS, Ritchie score, morning stiffness duration, and total radiographic score.

Conclusions: Baseline prognostic factors for remission in early rheumatoid arthritis were mainly clinical markers of disease activity and radiological scores.

Full Text

The Full Text of this article is available as a PDF (76K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. [PubMed]
  • Scott DL, Symmons DP, Coulton BL, Popert AJ. Long-term outcome of treating rheumatoid arthritis: results after 20 years. Lancet. 1987 May 16;1(8542):1108–1111. [PubMed]
  • Pope RM. Rheumatoid arthritis: pathogenesis and early recognition. Am J Med. 1996 Feb 26;100(2A):3S–9S. [PubMed]
  • Smolen JS, Kalden JR, Scott DL, Rozman B, Kvien TK, Larsen A, Loew-Friedrich I, Oed C, Rosenburg R. Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. European Leflunomide Study Group. Lancet. 1999 Jan 23;353(9149):259–266. [PubMed]
  • Weinblatt ME, Kremer JM, Bankhurst AD, Bulpitt KJ, Fleischmann RM, Fox RI, Jackson CG, Lange M, Burge DJ. A trial of etanercept, a recombinant tumor necrosis factor receptor:Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med. 1999 Jan 28;340(4):253–259. [PubMed]
  • Maini R, St Clair EW, Breedveld F, Furst D, Kalden J, Weisman M, Smolen J, Emery P, Harriman G, Feldmann M, et al. Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group. Lancet. 1999 Dec 4;354(9194):1932–1939. [PubMed]
  • Pinals RS, Masi AT, Larsen RA. Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum. 1981 Oct;24(10):1308–1315. [PubMed]
  • Wolfe F, Lassere M, van der Heijde D, Stucki G, Suarez-Almazor M, Pincus T, Eberhardt K, Kvien TK, Symmons D, Silman A, et al. Preliminary core set of domains and reporting requirements for longitudinal observational studies in rheumatology. J Rheumatol. 1999 Feb;26(2):484–489. [PubMed]
  • van der Heijde DM, van 't Hof M, van Riel PL, van de Putte LB. Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol. 1993 Mar;20(3):579–581. [PubMed]
  • Prevoo ML, van Gestel AM, van T Hof MA, van Rijswijk MH, van de Putte LB, van Riel PL. Remission in a prospective study of patients with rheumatoid arthritis. American Rheumatism Association preliminary remission criteria in relation to the disease activity score. Br J Rheumatol. 1996 Nov;35(11):1101–1105. [PubMed]
  • Ritchie DM, Boyle JA, McInnes JM, Jasani MK, Dalakos TG, Grieveson P, Buchanan WW. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med. 1968 Jul;37(147):393–406. [PubMed]
  • Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. [PubMed]
  • Meyer O, Labarre C, Dougados M, Goupille Ph, Cantagrel A, Dubois A, Nicaise-Roland P, Sibilia J, Combe B. Anticitrullinated protein/peptide antibody assays in early rheumatoid arthritis for predicting five year radiographic damage. Ann Rheum Dis. 2003 Feb;62(2):120–126. [PMC free article] [PubMed]
  • Meyer O, Tauxe F, Fabregas D, Gabay C, Goycochea M, Haim T, Elias A, Kahn MF. Anti-RA 33 antinuclear autoantibody in rheumatoid arthritis and mixed connective tissue disease: comparison with antikeratin and antiperinuclear antibodies. Clin Exp Rheumatol. 1993 Sep-Oct;11(5):473–478. [PubMed]
  • Hayem G, De Bandt M, Palazzo E, Roux S, Combe B, Eliaou JF, Sany J, Kahn MF, Meyer O. Anti-heat shock protein 70 kDa and 90 kDa antibodies in serum of patients with rheumatoid arthritis. Ann Rheum Dis. 1999 May;58(5):291–296. [PMC free article] [PubMed]
  • Combe B, Eliaou JF, Daurès JP, Meyer O, Clot J, Sany J. Prognostic factors in rheumatoid arthritis. Comparative study of two subsets of patients according to severity of articular damage. Br J Rheumatol. 1995 Jun;34(6):529–534. [PubMed]
  • Combe B, Dougados M, Goupille P, Cantagrel A, Eliaou JF, Sibilia J, Meyer O, Sany J, Daurès JP, Dubois A. Prognostic factors for radiographic damage in early rheumatoid arthritis: a multiparameter prospective study. Arthritis Rheum. 2001 Aug;44(8):1736–1743. [PubMed]
  • van der Heijde DM, van Riel PL, Nuver-Zwart IH, Gribnau FW, vad de Putte LB. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet. 1989 May 13;1(8646):1036–1038. [PubMed]
  • Wolfe F, Hawley DJ. Remission in rheumatoid arthritis. J Rheumatol. 1985 Apr;12(2):245–252. [PubMed]
  • Alarcón GS, Blackburn WD, Jr, Calvo A, Castañeda O. Evaluation of the American Rheumatism Association preliminary criteria for remission in rheumatoid arthritis: a prospective study. J Rheumatol. 1987 Feb;14(1):93–96. [PubMed]
  • Eberhardt K, Fex E. Clinical course and remission rate in patients with early rheumatoid arthritis: relationship to outcome after 5 years. Br J Rheumatol. 1998 Dec;37(12):1324–1329. [PubMed]
  • Möttönen T, Paimela L, Ahonen J, Helve T, Hannonen P, Leirisalo-Repo M. Outcome in patients with early rheumatoid arthritis treated according to the "sawtooth" strategy. Arthritis Rheum. 1996 Jun;39(6):996–1005. [PubMed]
  • Mazières B, Arlet J, Thalmann MD, Vidal R, Bismuth M. La rémission de la polyarthrite rhumatoïde. A propos de 32 observations. Rev Rhum Mal Osteoartic. 1985 Jul-Sep;52(7-9):445–450. [PubMed]
  • Harrison BJ, Symmons DP, Brennan P, Barrett EM, Silman AJ. Natural remission in inflammatory polyarthritis: issues of definition and prediction. Br J Rheumatol. 1996 Nov;35(11):1096–1100. [PubMed]
  • Nissilä M, Isomäki H, Kaarela K, Kiviniemi P, Martio J, Sarna S. Prognosis of inflammatory joint diseases. A three-year follow-up study. Scand J Rheumatol. 1983;12(1):33–38. [PubMed]
  • Wolfe F, Ross K, Hawley DJ, Roberts FK, Cathey MA. The prognosis of rheumatoid arthritis and undifferentiated polyarthritis syndrome in the clinic: a study of 1141 patients. J Rheumatol. 1993 Dec;20(12):2005–2009. [PubMed]
  • Eberhardt KB, Rydgren LC, Pettersson H, Wollheim FA. Early rheumatoid arthritis--onset, course, and outcome over 2 years. Rheumatol Int. 1990;10(4):135–142. [PubMed]
  • Molenaar ETH, Voskuyl AE, van der Horst-Bruinsma IE, Schreuder G M Th, Zanelli E, Dijkmans BAC. Influence of HLA polymorphism on persistent remission in rheumatoid arthritis. Ann Rheum Dis. 2002 Apr;61(4):351–353. [PMC free article] [PubMed]
  • Möttönen Timo, Hannonen Pekka, Korpela Markku, Nissilä Martti, Kautiainen Hannu, Ilonen Jorma, Laasonen Leena, Kaipiainen-Seppänen Oili, Franzen Per, Helve Tapani, et al. Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum. 2002 Apr;46(4):894–898. [PubMed]
  • Gough A, Faint J, Salmon M, Hassell A, Wordsworth P, Pilling D, Birley A, Emery P. Genetic typing of patients with inflammatory arthritis at presentation can be used to predict outcome. Arthritis Rheum. 1994 Aug;37(8):1166–1170. [PubMed]
  • van Zeben D, Hazes JM, Zwinderman AH, Cats A, Schreuder GM, D'Amaro J, Breedveld FC. Association of HLA-DR4 with a more progressive disease course in patients with rheumatoid arthritis. Results of a followup study. Arthritis Rheum. 1991 Jul;34(7):822–830. [PubMed]
  • Dougados M, Combe B, Cantagrel A, Goupille P, Olive P, Schattenkirchner M, Meusser S, Paimela L, Rau R, Zeidler H, et al. Combination therapy in early rheumatoid arthritis: a randomised, controlled, double blind 52 week clinical trial of sulphasalazine and methotrexate compared with the single components. Ann Rheum Dis. 1999 Apr;58(4):220–225. [PMC free article] [PubMed]
  • Möttönen T, Hannonen P, Leirisalo-Repo M, Nissilä M, Kautiainen H, Korpela M, Laasonen L, Julkunen H, Luukkainen R, Vuori K, et al. Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. FIN-RACo trial group. Lancet. 1999 May 8;353(9164):1568–1573. [PubMed]
  • Möttönen Timo, Hannonen Pekka, Korpela Markku, Nissilä Martti, Kautiainen Hannu, Ilonen Jorma, Laasonen Leena, Kaipiainen-Seppänen Oili, Franzen Per, Helve Tapani, et al. Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum. 2002 Apr;46(4):894–898. [PubMed]
  • Molenaar Esmeralda T H, Voskuyl Alexandre E, Dijkmans Ben A C. Functional disability in relation to radiological damage and disease activity in patients with rheumatoid arthritis in remission. J Rheumatol. 2002 Feb;29(2):267–270. [PubMed]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles
  • Substance
    Substance
    PubChem Substance links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...