title: Factors influencing remission in rheumatoid arthritis patients: results from Karnataka rheumatoid arthritis comorbidity (KRAC) study.
abstract: OBJECTIVE
  To study the prevalence of remission in rheumatoid arthritis (RA) patients and the influence of different factors like literacy, socioeconomic status, presence of comorbidity and treatment strategy in achieving remission.
  
  
  METHODS
  The study involved 1990 RA patients who were recruited for the Karnataka Rheumatoid arthritis comorbidity (KRAC) study. Based on the factors evaluated, the study participants were classified as follows: age, < 30 years, 30-39 years, 40-49 years, 50-59 years and ≥ 60 years; educational status, illiterate/no formal education, high school or less, graduate, post-graduate and doctorate; family income (₹ per annum), < 50 000, 50-100 000, 100-500 000, and > 500 000; duration of illness prior (DOIP): ≤ 6 months, 6-24 months, 24-120 months and > 120 months. Joint counts were performed by a rheumatologist or trained joint assessor. To assess the treatment outcome, the disease activity score was calculated using the Disease activity Score of 28 joints - erythrocyte sedimentation rate (DAS 28-3 ESR).
  
  
  RESULTS
  As per the DAS 28-3 ESR score, around 20% (n = 397) of the study subjects achieved remission. The corresponding mean ± SD of DAS 28-3 ESR noted for remission and non-remission groups were 2.13 ± 0.42 and 4.32 ± 1.28. The majority of the patients were treated with double disease-modifying anti-rheumatic drugs (DMARDs) (60.7%). The likelihood of remission was found to be more in patients who reported DOIP ≤ 6 months. Furthermore, the chances of remission reduced with increase in patient's age and the highest remission rate was noted for 30-39 years age group (59%), followed by 40-49 years (35.4%) and 50-59 years (19.7%).
  
  
  CONCLUSIONS
  The prevalence of remission noted was around 20%. Early treatment, escalating dose of DMARDs, and patient counseling are important contributing factors for attaining remission.
authors.affiliation: ChanRe Rheumatology and Immunology Center, Bangalore, India.
authors.forename: S
authors.initials: S
authors.lastname: Chandrashekara
authors.affiliation: St. John's Medical College Hospital, Bangalore, India.
authors.forename: Vineeta
authors.initials: V
authors.lastname: Shobha
authors.affiliation: Sakra Hospital, Bangalore, India.
authors.forename: B G
authors.initials: BG
authors.lastname: Dharmanand
authors.affiliation: Kanva Diagnostics Center, Bangalore, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Jois
authors.affiliation: Columbia Asia Hospital, Bangalore, India.
authors.forename: Sharath
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Samarpan Health Centre, Bangalore, India.
authors.forename: Kurugodu M
authors.initials: KM
authors.lastname: Mahendranath
authors.affiliation: Arthritis Superspeciality Center, Hubli, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Haridas
authors.affiliation: Vikram Hospital Pvt. Ltd, Mysore, India.
authors.forename: Shiva
authors.initials: S
authors.lastname: Prasad
authors.affiliation: Manipal Hospital, Mysore, Karnataka, India.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Singh
authors.affiliation: Narayana Health City, Mysore, Karnataka, India.
authors.forename: Manisha A
authors.initials: MA
authors.lastname: Daware
authors.affiliation: Anurag Clinic, Mysore, Karnataka, India.
authors.forename: Anupama
authors.initials: A
authors.lastname: Swamy
authors.affiliation: JSS Medical College, Mysore, Karnataka, India.
authors.forename: R
authors.initials: R
authors.lastname: Subramanian
authors.affiliation: Bangalore Rheumatology Center, Bangalore, India.
authors.forename: Srirama A
authors.initials: SA
authors.lastname: Somashekar
authors.affiliation: Arushi Rheumatology Center, Tumkur, India.
authors.forename: Arun M
authors.initials: AM
authors.lastname: Shanthappa
authors.affiliation: ChanRe Rheumatology and Immunology Center, Basaweswaranagar, Bangalore, India.
authors.forename: K R
authors.initials: KR
authors.lastname: Anupama
mesh_terms: D000328:Adult; D000367:Age Factors; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D064890:Social Determinants of Health; D012959:Socioeconomic Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: Karnataka rheumatoid arthritis comorbidity; disease-modifying anti-rheumatic drugs; remission; rheumatoid arthritis