Outcome of patients with rheumatoid arthritis: cross-sectional study of a single-center real-world inception cohort.
BACKGROUND
Tight control of disease activity is the recommended target of therapy for rheumatoid arthritis (RA).


OBJECTIVE
To determine the outcome of RA with respect to disease activity and the rate of remission, as measured by the DAS-28, in a real-world inception cohort.


METHODS
We conducted an observational cross-sectional study of a single-center real-world inception cohort of 101 consecutive patients being treated for RA in 2009-2010 in a rheumatology outpatient clinic. Patients were managed at the discretion of the attending rheumatologist with the goal of achieving remission. DAS-28 scores were calculated and analyzed by clinical and treatment variables derived from the medical files.


RESULTS
Mean patient age was 58.6 +/- 13.4 years and mean duration of disease 10.7 +/- 7.9years. Disease remission (DAS-28 < 2.6) was achieved in 26.7% of patients and low disease activity (> 2 .6 DAS-28 < 3.2) in 17%. Monotherapy with a conventional disease-modifying anti-rheumatic drug (C-DMARD, 21% of patients at last follow-up) was associated with a significantly lower mean DAS-28 score and C-reactive protein level than combined C-DMARD treatment (79% of patients), and with shorter disease duration than combined treatment with C-DMARDs or C-DMARD(s)+biological DMARD (40% of patients). Rheumatoid factor and anti-cyclic citrullinated peptide positivity had no effect on DAS-28 scores. Time from diagnosis was inversely correlated with DAS-28 scores.


CONCLUSIONS
The achievement of low disease activity and remission in a significant portion of our inception cohort of patients with RA suggests that the treat-to-target strategy is feasible and effective in routine clinical practice.
Rheumatology Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.
Eduard
E
Ling
Department of Internal Medicine H, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.
Shachaf
S
Ofer-Shiber
Anesthesiology and Intensive Care Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Or
O
Goren
Rheumatology Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.
Yair
Y
Molad
D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D001323:Autoantibodies / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000097:blood; D007557:Israel; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062072:Patient Acuity; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D001323:Autoantibodies; D007155:Immunologic Factors; D002097:C-Reactive Protein