Obesity in women and current smoking in men predict lack of remission in early RA

The results of a study presented today at the Annual European Congress of Rheumatology (EULAR 2018) report that obesity in women and current smoking in men were the strongest predictors of not achieving remission in early rheumatoid arthritis (RA) within a year.

Although early identification and aggressive treatment of RA improves outcomes, this study showed that 46% of women and 38% of men did not achieve remission in the first year despite receiving guideline-based care. Multivariable analysis highlighted that obesity more than doubled the likelihood of not achieving remission in women. Other predictors were minority status, lower education, higher tender joint counts and fatigue scores at baseline. In men, current smoking was associated with 3.5 greater odds of not achieving remission within the first year. Other predictors included older age and higher pain.

"These results highlight the need to support physicians and empower patients to take advantage of the impact lifestyle changes can have on disease progression," said Professor Johannes W. Bijlsma, EULAR President. "We consider it essential that recommendations reach all audiences—from rheumatologists, patients and patient organisations to healthcare professionals—in order to support all in understanding how to best manage the disease."

Almost all patients within the study were initially treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), with three quarters being treated with methotrexate. Analysis demonstrated that not using methotrexate significantly increased the likelihood of not achieving remission in women by 28% and men by 45%.

"Our results suggest that lifestyle changes—smoking cessation in men and weight reduction in women—as well as optimising methotrexate use may facilitate rapid reduction of inflammation, an essential goal of treatment in early rheumatoid arthritis," said Susan J. Bartlett, Professor of Medicine at McGill University (study author).

The study included 1,628 adults with early RA enrolled in the Canadian Early Arthritis Cohort (2007-16) and receiving guideline-based care. Baseline sociodemographic and RA characteristics and patient reported outcomes over 12 months were used to identify predictors of failing to achieve remission (defined as DAS28>2.6). Participants were mostly female (72%) with an average age of 55. They had an average of two comorbidities, and symptom duration of six months.