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Clinical remission of rheumatoid arthritis in a multicenter real-world study in Asia-Pacific region

Sun X 1 , Li R 1 , Cai Y 2 , Al-Herz A 3 , Lahiri M 4 , Choudhury MR 5 Show all authors , Hidayat R 6 , Suryana BPP 7 , Kaneko Y 8 , Fujio K 9 , Van Hung N 10 , Pandya S 11 , Pang LK 12 , Katchamart W 13 , Sigdel KR 14 , Paudyal B 14 , Narongroeknawin P 15 , Chevaisrakul P 16 , Sun F 17 , Lu Y 18 , Ho C 19 , Yeap SS 20 , Li Z 1 , APLAR RA SIG group

Affiliations 

  • 1 Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South St., Beijing 100044, China
  • 2 Department of Rheumatology & Immunology, Peking University Shenzhen Hospital, Shenzhen, China
  • 3 Rheumatology Unit, Department of Internal Medicine, Al-Amiri Hospital, Kuwait City, Kuwait
  • 4 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 5 Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 6 Department of Internal Medicine, Cipto Mangunkusumo National Hospital Faculty of Medicine, Universitas Indonesia, Jakarta
  • 7 Rheumatology Division, Internal Medicine Department, Brawijaya University - Saiful Anwar Hospital, Indonesia
  • 8 Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
  • 9 Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  • 10 Department of Rheumatology, Bach Mai Hospital, Giai Phong Road, Dong Da District, Hanoi, Vietnam
  • 11 Vedanta institute of medical sciences and VS hospital, Ahmedabad, India
  • 12 Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
  • 13 Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 14 Department of Internal Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
  • 15 Division of Rheumatology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
  • 16 Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 17 Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
  • 18 School of Mathematical Science, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
  • 19 Division of Rheumatology, Dept of Medicine, The University of Hong Kong, Hong Kong SAR, China
  • 20 Department of Medicine, Subang Jaya Medical Centre, Selangor
Lancet Reg Health West Pac, 2021 Oct;15:100240.
PMID: 34528015 DOI: 10.1016/j.lanwpc.2021.100240

Abstract

Background: Clinical remission is an attainable goal for Rheumatoid Arthritis (RA). However, data on RA remission rates from multinational studies in the Asia-Pacific region are limited. We conducted a cross-sectional multicentric study to evaluate the clinical remission status and the related factors in RA patients in the Asia-Pacific region.

Methods: RA patients receiving standard care were enrolled consecutively from 17 sites in 11 countries from APLAR RA SIG group. Data were collected on-site by rheumatologists with a standardized case-report form. Remission was analyzed by different definitions including disease activity score using 28 joints (DAS28) based on ESR and CRP, clinical disease activity index (CDAI), simplified disease activity index (SDAI), Boolean remission definition, and clinical deep remission (CliDR). Logistic regression was used to determine related factors of remission.

Findings: A total of 2010 RA patients was included in the study, the overall remission rates were 62•3% (DAS28-CRP), 35•5% (DAS28-ESR), 30•8% (CDAI), 26•5% (SDAI), 24•7% (Boolean), and 17•1% (CliDR), respectively, and varied from countries to countries in the Asia-Pacific region. Biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) prescription rate was low (17•9%). Compared to patients in non-remission, patients in remission had higher rates of b/tsDMARDs usage and lower rates of GC usage. The favorable related factors were male sex, younger age, fewer comorbidities, fewer extra-articular manifestations (EAM), and use of b/tsDMARDs, while treatment with GC was negatively related to remission.

Interpretation: Remission rates were low and varied in the Asia-Pacific region. Treatment with b/tsDMARDs and less GC usage were related to higher remission rate. There is an unmet need for RA remission in the Asia-Pacific region.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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