title: Patient-reported outcomes as predictors of remission in early rheumatoid arthritis patients treated with tight control treat-to-target approach.
abstract: Identifying prognostic factors for remission in early rheumatoid arthritis (ERA) patients is of key clinical importance. We studied patient-reported outcomes (PROs) as predictors of remission in a clinical trial. We randomized 99 untreated ERA patients to receive remission-targeted treatment with three disease-modifying antirheumatic drugs and prednisolone for 24 months, and infliximab or placebo for the initial 6 months. At baseline, we measured following PROs: eight Short Form 36 questionnaire (SF-36) dimensions, patient's global assessment [PGA, visual analogue scale (VAS)], Health Assessment Questionnaire (HAQ), and pain VAS. We used multivariable-adjusted regression models to identify PROs that independently predicted modified American College of Rheumatology remission at 2 years. Follow-up data at 2 years were available for 93 patients (92%), and 58 patients (62%) were in remission. At baseline, patients who achieved remission had higher radiological score (p = 0.04), lower tender joint count (p = 0.001), lower PGA (p = 0.005) and physician's global assessment (p = 0.019), lower HAQ (p = 0.016), less morning stiffness (p = 0.009), and significantly higher scores in seven out of eight SF-36 dimensions compared with patients who did not. In multivariable models that included all PROs, remission was associated with SF-36 dimensions higher vitality (odds ratio 2.01; 95% confidence interval 1.19-3.39) and better emotional role functioning (odds ratio 1.64; 95% confidence interval 1.01-2.68). PGA, pain VAS, HAQ, and other SF-36 dimensions were not associated with remission. We conclude that self-reported vitality and better emotional role functioning are among the most important PROs for the prediction of remission in ERA.
authors.affiliation: Department of Internal Medicine, University of Turku and Turku University Hospital, Kiinanmyllynkatu 4-6, PO BOX 52, 20521, Turku, Finland. laura.kuusalo@utu.fi.
authors.forename: Laura
authors.identifier: http://orcid.org/0000-0001-5238-8439
authors.initials: L
authors.lastname: Kuusalo
authors.affiliation: South-Karelia Central Hospital, Valto Käkelän katu 1, 53130, Lappeenranta, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Puolakka
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, P.O. Box 20, 00014, Helsinki, Finland.|Unit of Primary Health Care, Kuopio University Hospital, KYS, P.O. Box 100, 70029, Kuopio, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: Department of Medicine, Oulu University Hospital, Kajaanintie 50, 90220, Oulu, Finland.
authors.forename: Anna
authors.initials: A
authors.lastname: Karjalainen
authors.affiliation: Seinäjoki Central Hospital, Hanneksenrinne 7, 60220, Seinäjoki, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Malmi
authors.affiliation: Satakunta Central Hospital, Steniuksenkatu 2, 26100, Rauma, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Yli-Kerttula
authors.affiliation: Rheumatology, University of Helsinki and Helsinki University Hospital, HUS, P.O. Box 372, 00029, Helsinki, Finland.
authors.forename: Marjatta
authors.initials: M
authors.lastname: Leirisalo-Repo
authors.affiliation: Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland.|School of Medicine, University of Tampere, 33014, Tampere, Finland.
authors.forename: Vappu
authors.initials: V
authors.lastname: Rantalaiho
mesh_terms: D000293:Adolescent; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate
keywords: Clinical trial; Health-Related Quality Of Life; Patient reported outcomes; Remission; Rheumatoid arthritis