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Smoking, obesity leading predictors of failing to achieve remission in RA
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AMSTERDAM — Obesity in women and smoking in men are the strongest predictors that a patient with rheumatoid arthritis, receiving guideline-based care, will fail to achieve remission in the first 12 months, according to findings presented at the EULAR Annual Congress.
“Since the RA guidelines have come out, we have seen that the rates of remission in rheumatoid arthritis have steadily increased,” Susan J. Bartlett, PhD, of McGill University, said during a press conference. “Just looking at Canadian data, about 5 years ago, a little less than half of patients who were in the first year of rheumatoid arthritis were not reaching remission. Last year, that rate increased to nearly 70%, so we are doing much better at getting most people to the target of therapy, but there is still a group of people who don’t reach that.”
To identify the predictors of persistent RA disease activity, and to determine if these factors differ by sex, Bartlett and colleagues studied 1,628 adults in the Canadian Early Arthritis Cohort, from 2007 to 2016. The participants, 72% of whom were women, had active disease at baseline, and most received treatment with conventional synthetic DMARDs, with 75% receiving methotrexate.
During the study, standardized visits included clinical assessment, questionnaires and laboratory tests. The researchers used logistic regression with backward selection to identify predictors for failing to reach remission, defined as a DAS28 of less than 2.6 by the first year, among baseline sociodemographic data, RA characteristics and patient-reported outcomes.
Overall, 46% of women and 38% of men failed to reach remission by 12 months, according to Bartlett. Among women, obesity more than doubled the likelihood that a patient would fall short of remission, she said. Other leading predictors included minority status, lower education and having not received methotrexate. In men, current smoking was associated with 3.5 times greater odds for not reaching remission in the first 12 months, Bartlett said, with the other leading predictors being older age and higher pain. Overall, not receiving methotrexate increased the likelihood of failing to achieve remission by 28% in women and 45% in men. Longer symptom duration was associated with not achieving remission in all participants.
“What this tells us is the importance of not only getting the right people the right treatment in a very timely matter, but also, thinking about the person sitting there in front of you as a rheumatologist,” Bartlett said. “If it is a woman, think about excess weight — that is definitely going to impact the efficacy of treatment. If it is a male — smoking. In our setting, rheumatologists typically do not address lifestyle behaviors — that is more in the domain of the general practitioner, and even general practitioners find that they do not necessarily have time. However, our data would suggest very strongly that if we want our medications to work as well as they can work, then we need to spend the time to help people address their health behaviors.” – by Jason Laday
Reference:
Bartlett S. Abstract OP0106. Presented at: EULAR Annual Congress; June 13-16, 2018; Amsterdam.
Disclosure: Bartlett reports no relevant financial disclosures.