:: Volume 25, Issue 6 (Bimonthly 2021) ::
Feyz 2021, 25(6): 1342-1353 Back to browse issues page
Long-term prognosis of rheumatoid arthritis disease: A multi centric retrospective cohort study
Kamal Esalatmanesh , Hamidreza Gilasi , Asma Ziarati , Mohammadjavad Azadchehr , Roozbeh Esalatmanesh
Medical Student, Kashan University of Medical Sciences, Kashan, I.R. Iran. , esalatr@gmail.com
Abstract:   (1427 Views)
Background: Rheumatoid arthritis is the most common chronic systemic inflammatory and autoimmune disease. Considering that one of the important goals of treatment of this disease is to achieve remission, this study was designed to identify the factors associated with the prognosis of this disease to select a treatment appropriate to its severity.
Materials and Methods: In this study, the records of 433 patients with rheumatoid arthritis were examined by several rheumatologists and their assistants in Tabriz and Kashan centers and the factors affecting the prognosis of patients using logistic regression test was determined.
Results: Results showed that the variables of disease duration, DAS28 at the first visit, treatment regimen and TNF inhibitors have a significant effect on patients' prognosis (P <0.05) so that with an increase of one unit (year) duration of the disease, the chance of a poor prognosis in patients increases 1.117 times; The chance of a poor prognosis among patients in whom the disease activity was severe at the beginning of the referral is 2.369 times higher than in patients in whom the disease activity was moderate; Also, the chance of a poor prognosis among patients on a mono-therapy regimen is 9.346 times higher than in patients on a double-therapy regimen.
Conclusion: Increasing duration of the disease, severe disease activity at the beginning of the visit, lack of commitment to treatment and use of a mono-therapy regimen at the beginning of treatment increase the chance of poor prognosis in patients.
Keywords: Rheumatoid arthritis, Long-term prognosis, Remission
Full-Text [PDF 396 kb]   (1041 Downloads)    
Type of Study: Research | Subject: medicine, paraclinic
Received: 2021/09/17 | Revised: 2023/11/1 | Accepted: 2021/11/13 | Published: 2022/02/1
1. Longo DL. Harrison's principles of internal medicine. 20th ed. New York: McGraw-Hill; 2018.
2. Nelson NL, Churilla JR. Massage Therapy for Pain and Function in Patients With Arthritis: A Systematic Review of Randomized Controlled Trials. Am J Phys Med Rehabil Association of Academic Physiatrists. 2017.
3. Pisetsky DS. Advances in the Treatment of Rheumatoid Arthritis Costs and Challenges. N C Med 2017; 78(5): 337-40.
4. Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for rheumatic diseases: a systematic review. Rheumatology (Oxford) 2013; 52(11): 2025-30.
5. Challal S, Minichiello E, Boissier MC, Semerano L. Cachexia and adiposity in rheumatoid arthritis. Relevance for disease management and clinical outcomes. Joint Bone Spine 2016; 83(2): 127-33.
6. Liu Y, Hazlewood GS, Kaplan GG, Eksteen B, Barnabe C. Impact of obesity on remission and disease activity in rheumatoid arthritis: a systematic review and meta‐analysis. Arthritis Care Res 2017; 69(2): 157-65.
7. Lin E, Limper AH, Moua T. Obliterative bronchiolitis associated with rheumatoid arthritis: analysis of a single-center case series. BMC Pulm Med 2018; 18(1): 105.
8. Sumer EU, Schaller S, Sondergaard BC, Tanko LB, Qvist P. Application of biomarkers in the clinical development of new drugs for chondroprotection in destructive joint diseases: a Review J Biomark 2006; 11(6): 485-506.
9. Nakajima A. Application of cellular genetherapy for rheumatoid arthritis. Mod Rheumatol 2006; 16(5): 269-75.
10. Noguchi H. [Application of chimeric and humanized antibodies to autoimmune diseases therapy]. Nihon Rinsho Japanese J Clin Med 1997; 55(6): 1549-56.
11. Hayashi H, Fujimaki C, Tsuboi S, Matsuyama T, Daimon T, Itoh K. Application of fluorescence polarization immunoassay for determination of methotrexate-polyglutamates in rheumatoid arthritis patients. Tohoku J Exp Med 2008; 215(1): 95-101.
12. Fujii T. [111th Scientific Meeting of the Japanese Society of Internal Medicine: Symposium: 1. Immunity and diseases in internal medicine; 2. Frontier of pathophysiology and treatment; 3. Pathophysiology and the recent treatment of rheumatoid arthritis]. Nihon Naika Gakkai Zasshi 2014; 103(9): 2111-5.
13. Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012; 64(5): 625-39.
14. Van Riel PL, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol 2016; 34(5 Suppl 101): S40-4.
15. Smolen J, Aletaha D. Assessment of rheumatoid arthritis activity in clinical trials and clinical practice. UpTo Date Retrieved Apr 17, 2020. Available at: https://www.uptodate.com/contents/ assessment-of-rheumatoid-arthritis-activity-in-clinical-trials-and-clinical-practice
16. Cook MJ, Diffin J, Scire CA, Lunt M, MacGregor AJ, Symmons DP et al. Predictors and outcomes of sustained, intermittent or never achieving remission in patients with recent onset inflammatory polyarthritis: results from the Norfolk Arthritis Register. Rheumatology (Oxford) 2016; 55(9): 1601-9.
17. Esalatmanesh K, Fayyazi H, Esalatmanesh R, Khabbazi A.The association between serum levels of growth differentiation factor-15 and rheumatoid arthritis activity. Int J Clin Pract 2020; 74(9): e13564.
18. Furst DE, Pangan AL, Harrold LR, Chang H, Reed G, Kremer JM et al. Greater likelihood of remission inrheumatoid arthritis patients treated earlier in the disease course: results from the Consortium of Rheumatology Researchers of North America registry. Arthritis Care Res (Hoboken) 2011; 63(6): 856-64.
19. van der Woude D, Young A, Jayakumar K, Mertens BJ, Toes RE, van der Heijde D, et al. Prevalence of and predictive factors for sustained disease-modifying antirheumatic drug-free remission in rheumatoid arthritis: results from two large early arthritis cohorts. Arthritis Rheumatol 2009; 60(8): 2262-71.
20. Nadrian H, Morovati SM, Mirzaei A, Bahmanpur K, Moradzadeh R, Shariati AM. Relationship Between Quality of Life, Health Status and Self-care Behaviors in patients. J Ilam Uni Med Sci 2011; 19(2): 15-25.
21. Khalvat A, Rostamian A, Najafizadeh SR, Meysami A. The effect of stress on prognosis and treatment response in 100 Rheumatoid Arthritis patients. Tehran Univ Med J 2007; 65(5): 6-10.
22. Vazquez I, Graell E, Gratacos J, Canete JD, Vinas O, Ercilla MG et al. Prognostic markers of clinical remission in early rheumatoid arthritis after two years of DMARDs in a clinical setting. Clin Exp Rheumatol 2007; 25(2): 231.
23. Ebrahimian S, Salami A, Malek Mahdavi A, Esalatmanesh K, Khabbazi A, Hajialilo M. Can treating rheumatoid arthritis with disease-modifying anti-rheumatic drugs at the window of opportunity with tight control strategy lead to long-term remission and medications free remission in real-world clinical practice? A cohort study. Clin Rheumatol 2021 Jun 23.
24. Esalatmanesh K, Loghman A, Esalatmanesh R, Soleimani Z, Khabbazi A, Mahdavi AM et al. Effects of melatonin supplementation on disease activity, oxidative stress, inflammatory, and metabolic parameters in patients with rheumatoid arthritis: a randomized double-blind placebo-controlled trial. Clin Rheumatol 2021; 40(9): 3591-97.
25. Hamann P, Holland R, Hyrich K, Pauling JD, Shaddick G, Nightingale A et al. Factors Associated with Sustained Remission in Rheumatoid Arthritis in Patients Treated With Anti–Tumor Necrosis Factor. Arthritis Care Res 2017; 69(6): 783-93.
26. Möttönen T, Paimela L, Leirisalo-Repo M, Kautiainen H, Ilonen J, Hannonen P. Only high disease activity and positive rheumatoid factor indicate poor prognosis in patients with early rheumatoid arthritis treated with “sawtooth” strategy. Ann Rheum Dis 1998; 57(9): 533-9.
27. Chehata JC, Hassell AB, Clarke SA, Mattey DL, Jones MA, Jones PW et al. Mortality in rheumatoid arthritis: relationship to single and composite measures of disease activity. Rheumatology 2001; 40(4): 447-52.
28. Wasserman A. Diagnosis and management of rheumatoid arthritis. Am Fam Physician 2011; 84(11): 1245-52.
29. Green M, Marzo‐Ortega H, McGonagle D, Wakefield R, Proudman S, Conaghan P et al. Persistence of mild, early inflammatory arthritis: the importance of disease duration, rheumatoid factor, and the shared epitope. Arthritis & Rheumatism: Official J Am College Rheumatol 1999; 42(10): 2184-8.
30. Van Nies JA, Tsonaka R, Gaujoux-Viala C, Fautrel B, Van Der Helm-Van Mil AH. Evaluating relationships between symptom duration and persistence of rheumatoid arthritis: does a window of opportunity exist? Results on the Leiden early arthritis clinic and ESPOIR cohorts. Ann Rheum Dis 2015; 74(5): 806-12.
31. Nilsson J, Andersson ML, Hafström I, Svensson B, Forslind K, Ajeganova S et al. Influence of Age and Sex on Disease Course and Treatment in Rheumatoid Arthritis. Open access rheumatology: Rev Res 2021; 13: 123.
32. Emery P, Pope JE, Kruger K, Lippe R, DeMasi R, Lula S et al. Efficacy of monotherapy with biologics and JAK inhibitors for the treatment of rheumatoid arthritis: a systematic review. Adv Ther 2018; 35(10): 1535-63.
33. Sizova L. Approaches to the treatment of early rheumatoid arthritis with disease‐modifying antirheumatic drugs. Br J Clin Pharmacol 2008; 66(2): 173-8.
34. Weinblatt ME. Methotrexate in Rheumatoid Arthritis: A Quarter Century of Development. Trans Am Clin Climatol Assoc 2013; 124: 16–25.
35. Kalden JR, Smolen JS, Emery P, van Riel PL, Dougados M, Strand CV et al. Lefunomide in combination therapy. J Rheumatol Suppl 2004; 71: 25-30.
36. Albers JM, Paimela L, Kurki P, Eberhardt KB, Emery P, van‘t Hof MA et al. Treatment strategy, disease activity, and outcome in four cohorts of patients with early rheumatoid arthritis. Ann Rheum Dis 2001; 60(5): 453-8.
37. Hua L, Du H, Ying M, Wu H, Fan J, Shi X. Efficacy and safety of low-dose glucocorticoids combined with methotrexate and hydroxychloroquine in the treatment of early rheumatoid arthritis: A single-center, randomized, double-blind clinical trial. Medicine 2020; 99(27).
38. Emery P, Sebba A, Huizinga TW. Biologic and oral disease-modifying antirheumatic drug monotherapy in rheumatoid arthritis. Ann Rheum Dis 2013; 72(12): 1897-904.
39. Derksen VF, Huizinga TW, Van Der Woude D. The role of autoantibodies in the pathophysiology of rheumatoid arthritis. Springer Berlin Heidelberg 2017; 39(4): 437-46.
40. Jin J, Chang Y, Wei W. Clinical application and evaluation of anti-TNF-alpha agents for the treatment of rheumatoid arthritis. Acta Pharmacol Sin 2010; 31(9): 1133-40.
41. Lipsky PE, van der Heijde DM, St. Clair EW, Furst DE, Breedveld FC, Kalden JR et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. N Engl J Med 2000; 343(22): 1594-602.
42. Alemao E, Bao Y, Weinblatt ME, Shadick N. Association of Seropositivity and Mortality in Rheumatoid Arthritis and the Impact of Treatment with Disease‐Modifying Antirheumatic Drugs: Results from a Real‐World Study. Arthritis Care Res 2020; 72(2): 176-83.
43. Choi ST, Lee KH. Clinical management of seronegative and seropositive rheumatoid arthritis: a comparative study. PLoS One 2018; 13(4): e0195550.
44. Li L, Cui Y, Yin R, Chen S, Zhao Q, Chen H et al. Medication adherence has an impact on disease activity in rheumatoid arthritis: a systematic review and meta-analysis. Patient Prefer Adherenc 2017; 11: 1343.
45. Nakagawa S, Nakaishi M, Hashimoto M, Ito H, Yamamoto W, Nakashima R et al. Effect of medication adherence on disease activity among Japanese patients with rheumatoid arthritis. PLoS One 2018; 13(11): e0206943.
46. Oh YJ, Park B, Moon KW. Effect of drug adherence on treatment outcome in Rheumatoid Arthritis. Int J Rheum Dis 2019; 26(4): 264-72.
47. Chang K, Yang SM, Kim SH, Han KH, Park SJ, Shin JI. Smoking and rheumatoid arthritis. Int J Mol Sci 2014; 15(12): 22279-95.

XML   Persian Abstract   Print

Creative Commons License
This open access journal is licensed under a Creative Commons Attribution-NonCommercial ۴.۰ International License. CC BY-NC ۴. Design and publishing by Kashan University of Medical Sciences.
Copyright ۲۰۲۳© Feyz Medical Sciences Journal. All rights reserved.
Volume 25, Issue 6 (Bimonthly 2021) Back to browse issues page