Factors influencing remission in rheumatoid arthritis patients: results from Karnataka rheumatoid arthritis comorbidity (KRAC) study

• Published in: International journal of rheumatic diseases 2018-11, Vol.21 (11), p.1977-1985
• Main Authors: Chandrashekara, S., Shobha, Vineeta, Dharmanand, B. G., Jois, Ramesh, Kumar, Sharath, Mahendranath, Kurugodu M., Haridas, Vikram, Prasad, Shiva, Singh, Yogesh, Daware, Manisha A., Swamy, Anupama, Subramanian, R., Somashekar, Srirama A., Shanthappa, Arun M., Anupama, K. R.
• Format: Article
• Language: English
• Subjects: Age; Comorbidity; disease‐modifying anti‐rheumatic drugs; Erythrocyte sedimentation rate; Joint diseases; Karnataka rheumatoid arthritis comorbidity; Patients; Remission; Rheumatoid arthritis
• ISSN: 1756-1841; 1756-185X
• DOI: 10.1111/1756-185X.12908

Aim 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%). Conclusion The prevalence of remission noted was around 20%. Early treatment, escalating dose of DMARDs, and patient counseling are important contributing factors for attaining remission.