title: Predictors of European League Against Rheumatism (EULAR) good response, DAS-28 remission and sustained responses to TNF-inhibitors in rheumatoid arthritis: a prospective study in refractory disease.
abstract: The aim of this study was to survey factors related to EULAR good response, the DAS-28 definition of remission, ACR 50 response, sustained response to tumor necrosis factor inhibitors (TNF-I) therapy in biologic naïve patients with refractory rheumatoid arthritis. This was a single center observational clinical prospective 2 years' study, EULAR response criteria, DAS 28, HAQ and radiographic changes were recorded. Eighty patients included (64 females and 16 males, mean age was 48.4 + -17.9 years, mean disease duration 7.3 + -5.9 years). At 6 months 70% achieved EULAR good response, 51.8% achieved DAS-28 remission. Good response/sustained responses inversely correlated with baseline DAS-28 and radiographic erosions P <0.05. EULAR good response/remission by 6 months, sustained response at 2 years positively correlated with the decline in RF titers (r = 0.33, P < 0.05 & r = 0.30, P < 0.03 respectively), negatively correlated with the baseline HAQ. Regression analysis identified higher serum hemoglobin concentration, lower baseline HAQ scores, and the absence of radiographic erosions as significant predictors of good as well as sustained responses after adjustment for potential covariates. Methotrexate was associated with favorable responses and remission at 6 months (ORs = 1.13, 1.30 respectively). The study concluded that a lower baseline DAS-28 and HAQ scores, the lack of radiographic erosions favored EULAR good response and were significant predictors of sustained response to TNF-I.
authors.affiliation: Rheumatology and Clinical Immunology, Department of Rheumatology and Rehabilitation, School of Medicine, Cairo University Hospitals, Cairo, Egypt ; Internal Medicine Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia.
authors.forename: Reem Hamdy A
authors.identifier: 0000-0003-4994-7687
authors.initials: RH
authors.lastname: Mohammed
authors.affiliation: Community Medicine, Munofia University, Munofia, Egypt ; Research Department Al Hada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia.
authors.forename: Faisal
authors.initials: F
authors.lastname: Farahat
authors.affiliation: Department of Radio-diagnosis, Faculty of Medicine, Mansoura University, Mansoura, Egypt ; Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia.
authors.forename: Hanady H
authors.initials: HH
authors.lastname: Kewan
authors.affiliation: Internal Medicine Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Bukhari
keywords: DAS-28 remission; EULAR good response; Refractory rheumatoid arthritis; Sustained responses; Tumor necrosis factor inhibitors