title: Achieving simplified disease activity index remission in patients with active rheumatoid arthritis is associated with subsequent good functional and structural outcomes in a real-world clinical setting under a treat-to-target strategy.
abstract: OBJECTIVE
  To verify predictive validity of simplified disease activity index (SDAI) remission for subsequent functional and structural outcomes in real-world clinical settings under a treat-to-target strategy (T2T).
  
  
  METHODS
  In this multicenter, prospective cohort study, T2T was implemented in rheumatoid arthritis (RA) patients with moderate-to-high disease activity. SDAI or clinical disease activity index (CDAI) was assessed every 12 weeks, and treatment was adjusted to achieve clinical remission or low disease activity (LDA). Multivariate logistic regression models were used to examine the associations of SDAI remission (≤3.3) at week 24 with the health assessment questionnaire-disability index (HAQ-DI) ≤ 0.5 or with the delta van der Heijde-modified total Sharp score (ΔvdH-mTSS) <smallest detectable change (SDC) at week 72.
  
  
  RESULTS
  Of 318 patients enrolled, 271 completed the follow-up for 72 weeks and were subjects of the analyses. Factors [odds ratio (95% confidence interval)] significantly associated with the HAQ-DI ≤0.5 were SDAI remission at week 24 [2.99 (1.42-6.28), p = 0.004], baseline HAQ-DI [0.28 (0.18-0.45), p = 1.3 × 10-7], and baseline vdH-mTSS [0.986 (0.976-0.996), p = 0.009]. A factor associated with ΔvdH-mTSS < SDC was SDAI remission at week 24 [3.53 (1.62-7.71), p = 0.002].
  
  
  CONCLUSIONS
  Predictive validity of SDAI remission for good outcomes was verified in a T2T-implementing cohort in the current clinical settings.
authors.affiliation: a Department of Pharmacovigilance.|b Department of Rheumatology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU) , Bunkyō , Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Hirano
authors.affiliation: a Department of Pharmacovigilance.|b Department of Rheumatology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU) , Bunkyō , Japan.
authors.forename: Waka
authors.initials: W
authors.lastname: Yokoyama
authors.affiliation: a Department of Pharmacovigilance.|b Department of Rheumatology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU) , Bunkyō , Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Yamazaki
authors.affiliation: c Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Saitama , Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Amano
authors.affiliation: d Unit of Translational Medicine, Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawakami
authors.affiliation: e Department of Rheumatology, Faculty of Medicine , University of Tsukuba , Tsukuba , Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: f Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Bunkyō , Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Tamura
authors.affiliation: g Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Yasuda
authors.affiliation: h Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine , Kagawa University , Takamatsu , Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Dobashi
authors.affiliation: i Department of the Control for Rheumatic Diseases , Graduate School of Medicine, Kyoto University , Kyoto , Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Fujii
authors.affiliation: j Department of Rheumatology , Niigata Rheumatic Center , Shibata , Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ito
authors.affiliation: k Division of Rheumatology, Department of Internal Medicine , Keio University School of Medicine , Minato , Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kaneko
authors.affiliation: l Department of Rheumatology , Sagamihara National Hospital, National Hospital Organization , Sagamihara , Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Matsui
authors.affiliation: m Department of Internal Medicine , Center for Rheumatic Diseases, Dohgo Spa Hospital , Matsuyama , Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Okuda
authors.affiliation: n The First Department of Internal Medicine , University of Occupational and Environmental Health, School of Medicine , Kitakyushu , Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
authors.affiliation: o Department of Rheumatology , Soka Municipal Hospital , Saitama , Japan.
authors.forename: Fumihito
authors.initials: F
authors.lastname: Suzuki
authors.affiliation: p Department of Hematology and Clinical Immunology , Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Yoshimi
authors.affiliation: a Department of Pharmacovigilance.|b Department of Rheumatology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU) , Bunkyō , Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sakai
authors.affiliation: a Department of Pharmacovigilance.|b Department of Rheumatology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU) , Bunkyō , Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Koike
authors.affiliation: b Department of Rheumatology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU) , Bunkyō , Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kohsaka
authors.affiliation: b Department of Rheumatology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU) , Bunkyō , Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyasaka
authors.affiliation: a Department of Pharmacovigilance.|b Department of Rheumatology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU) , Bunkyō , Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Harigai
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012074:Remission Induction / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: Health assessment questionnaire; Modified Sharp score; Rheumatoid arthritis; Simplified disease activity index; Treat-to-target