Factors associated with sustained remission in patients with rheumatoid arthritis

Elevation of erythrocyte sedimentation rate and C-reactive protein levels reflects renal interstitial inflammation in drug-induced acute tubulointerstitial nephritis

BACKGROUND

A renal biopsy is needed to define active inflammatory infiltration and guide therapeutic management in drug-induced acute tubulointerstitial nephritis (D-ATIN). However, factors such as various contraindications, refusal of informed consent and limited technical support may stop the biopsy process. It is thus of great importance to explore approaches that could deduce probable pathologic changes.

METHODS

A total of 81 biopsy-proven D-ATIN patients were enrolled from a prospective cohort of ATIN patients at Peking University First Hospital. The systemic inflammation score (SIS) was developed based on the CRP and ESR levels at biopsy, and patients were divided into high-SIS, median-SIS, and low-SIS groups. The demographic data, clinicopathologic features, and renal outcomes were compared.

RESULTS

The SIS was positively correlated with inflammatory cell infiltration and was inversely correlated with interstitial fibrosis. The number of interstitial inflammatory cells increased significantly with increasing SISs. The proportions of neutrophils and plasma cells were the highest in the high-SIS group compared with the other two groups. Prednisone (30-40 mg/day) was prescribed in all patients. The high-SIS group tended to have more favorable renal restoration than the other two groups. By 12 months postbiopsy, a decreased eGFR (< 60 mL/min/1.73 m²) was observed in 66.7% of medium-SIS patients, 32.4% of high-SIS patients, and 30.4% of low-SIS patients.

CONCLUSION

The SIS was positively correlated with active tubulointerstitial inflammation and therefore could help to aid therapeutic decisions in D-ATIN.

Association between pain phenotype and disease activity in rheumatoid arthritis patients: a non-interventional, longitudinal cohort study

BACKGROUND

In well-controlled rheumatoid arthritis (RA) without significant joint damage, a substantial proportion of patients complain of persistent pain. Previous studies have identified different pain phenotypes in RA, in which non-nociceptive pain phenotypes are associated with higher concurrent disease activity scores. In this longitudinal study, we explored associations between pain phenotypes and long-term disease activity outcome in RA patients. Secondly, we explored whether pain phenotype is associated with comorbid conditions.

METHODS

One hundred eighty established RA patients were classified with a nociceptive (61%) or a non-nociceptive (39%) pain phenotype, based on their responses to the painDETECT-questionnaire. Two years of clinical follow-up data on disease activity outcomes were collected. Information on comorbid diseases was derived from electronic patient files.

RESULTS

Patients with a non-nociceptive pain phenotype showed higher mean disease activity scores (DAS28, 2.57; 95% CI, 2.37-2.77 vs. 2.11; 95% CI, 1.94-2.27; p < 0.001) and a twofold lower chance of achieving sustained DAS28 remission (OR = 0.49; 95% CI, 0.26-0.92; p = 0.020). Only the tender joint count and patient global health significantly differed between the pain phenotype groups. Patients with a non-nociceptive pain phenotype had more often been diagnosed with concurrent fibromyalgia (9.9% vs. 0.9%; p = 0.007) and other pain-associated comorbid diseases (52.1% vs. 35.8%; p = 0.030) compared with patients with a nociceptive pain phenotype.

CONCLUSION

This longitudinal study showed consistently worse long-term disease activity outcomes in RA patients with a non-nociceptive pain phenotype which appeared to be mainly due to differences in the subjective components of the disease activity score.

TRIAL REGISTRATION

The DREAM cohort study is registered in the Netherlands Trial Register: NTR578.

Predictors and the optimal duration of sustained remission in rheumatoid arthritis

OBJECTIVE

To determine predictors and optimal duration of sustained remission (SR) in patients with rheumatoid arthritis (RA).

METHODS

A total of 428 consecutive patients with RA visiting our clinic routinely between 2012 and 2013 were evaluated. Seventy seven of these patients in DAS28 remission were enrolled and followed up for 62.2 ± 9.9 months. Patients in remission ≥ 6 months (SR) and shorter (non: N-SR) were compared in terms of demographic-clinical data and the psychosocial factors. At enrollment, 1st and 5th years, patients in DAS28, SDAI, and Boolean remission were determined.

RESULTS

Sixty three patients were in SR and 14 in N-SR. Lower baseline DAS28 and HAQ scores, anti-CCP were positive predictors of SR. Although the presence of anxiety, depression, fibromyalgia, and fatigue were lower in the SR group, there was no significance. Patients in DAS28 remission (100%) at baseline reduced to 64% at 1st and 42.6% at 5th years. Patients satisfying SDAI and Boolean remission at these three visits were 49%, 44%, and 32.4% vs 41%, 28%, and 20.6%, respectively. If the duration of remission is defined as 6 months, the remission rates of SDAI at inclusion and fifth years' visits were similar but Boolean remission rates differed significantly and if it is accepted as ≥ 12 months, both the SDAI and Boolean remission rates were not different.

CONCLUSION

Low DAS28 and HAQ scores at baseline, anti-CCP were positive predictors of SR. Instead of 6 months, remission duration for ≥ 12 months would probably help us to predict SR independently from the chosen criteria; Boolean or SDAI.

Improved flare and remission pattern in rheumatoid arthritis over recent decades: a population-based study

Objective

To assess trends in the occurrence of flares and remission in RA over recent decades.

Methods

A retrospective medical records review of each clinical visit was performed in a population-based cohort of patients with RA (age ⩾30 years; 1987 ACR criteria met in 1988-2007) to estimate flare and remission status. RA flare was defined as any worsening of RA activity leading to an initiation, change or increase of therapy (OMERACT 9). The primary definition for remission required the absence of RA disease activity (i.e. tender joint count 0, swollen joint count 0 and ESR ⩽10 mm/h) (OMERACT 7). All subjects were followed until death, migration or 1 July 2012.

Results

The study included 650 RA patients (mean age 55.8 years; 69% female) with a mean follow up of 10.3 years. Patients were flaring at 2887 (17%) visits. There was a significant decline in the RA flare rate across disease duration (P < 0.001), predominantly in the first 5 years after diagnosis of RA. Patients diagnosed with RA in more recent years experienced fewer flares during first few years of RA (P < 0.001). There was no difference between the sexes in trends of flare rates over time (P = 0.42) Current smokers had higher flare rates than non-smokers (P = 0.047) and former smokers were not different from non-smokers (P = 0.87).

Conclusion

Patients diagnosed in more recent years have lower flare rates than those diagnosed in prior decades. Flare rates declined fastest in the first 5 years of disease and tended to be stable thereafter. Current smoking was associated with an adverse flare profile.