Clinical conditions needed to acquire sustained functional remission in rheumatoid arthritis patients
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ORIGINAL ARTICLE
Clinical conditions needed to acquire sustained functional remission in rheumatoid arthritis patients Ryousuke Koizumi 1,2 & Kensuke Koyama 1,2 & Masanori Wako 1 & Tetsuro Ohba 1 & Yoshihiro Takayama 1 & Hirotaka Haro 1 Received: 27 August 2020 / Revised: 29 September 2020 / Accepted: 6 October 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Objectives Treatments aimed at maintaining sustained clinical remission in rheumatoid arthritis (RA) patients have been recommended by several groups. Improvement and maintenance of functional status are also important for RA patients. The purpose of this study was to investigate the factors for maintaining long-term functional remission. Methods RA patients with usual care without specific protocols were included. Disease activity score using 28-joint count Creactive protein (DAS28-CRP), simplified disease activity index (SDAI) score, and Health Assessment Questionnaire Disability Index (HAQ-DI) score was calculated every 3 months for 1 year. Patients were divided into the HAQ-DI remission (REM) group and the HAQ-DI non-remission (NO-REM) group; time-averaged values of these parameters were compared between groups. Results Of the 205 patients, 154 fulfilled the remission criteria. Time-averaged DAS28-CRP and SDAI score were significantly lower in the REM group than in the NO-REM group (1.66 vs 2.59, 3.54 vs 10.68, respectively; p < 0.001). Subsequent receiveroperating characteristic (ROC) analysis for estimation of remission indicated a cut-off value of 1.65 for time-averaged DAS28CRP and 2.85 for time-averaged SDAI score. Conclusions Previous reports showed that fulfillment of clinical remission increases the possibility of functional remission; the probability of which is higher in patients with sustained clinical remission. Sustained clinical remission is required to achieve sustained functional remission; the criteria for clinical remission may be more stringent. Key Points • Sustained deep clinical remission was required to achieve sustained functional remission.
Keywords DAS28-CRP . Health Assessment Questionnaire Disability Index . Remission . Rheumatoid arthritis . SDAI
Introduction Improvement and maintenance of quality of life (QOL) and activities of daily living (ADL) are important goals of rheumatoid arthritis (RA) treatment. Functional outcomes in RA
* Kensuke Koyama [email protected] 1
Department of Orthopedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
2
Department of Orthopedic Surgery, Kyonan Medical Center Fujikawa Hospital, 340-1 Kajikazawa, Fujikawa, Yamanashi 400-0601, Japan
are the result of disease activity over time [1]. The European League Against Rheumatism (EULAR) statement recommended that treatment of RA should be aimed at reaching a target of sustained clinical remission or low disease activity (LDA) to improve long-term prognosis [2]. Sustained clinical remission periods were a strong predictor of retained good physical fun
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