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LUANA MANCARELLA, FRANCESCA BOBBIO-PALLAVICINI, FULVIA CECCARELLI, PAOLA CHIARA FALAPPONE, ANGELO FERRANTE, DOMENICO MALESCI, ALFONSO MASSARA, FRANCESCA NACCI, MARIA ELENA SECCHI, STEFANIA MANGANELLI, FAUSTO SALAFFI, MARIA LISA BAMBARA, STEFANO BOMBARDIERI, MAURIZIO CUTOLO, CLODOVEO FERRI, MAURO GALEAZZI, ROBERTO GERLI, ROBERTO GIACOMELLI, WALTER GRASSI, GIOVANNI LAPADULA, MARCO MATUCCI CERINIC, CARLOMAURIZIO MONTECUCCO, FRANCESCO TROTTA, GIOVANNI TRIOLO, GABRIELE VALENTINI, GUIDO VALESINI, GIANFRANCO F. FERRACCIOLI, for the GISEA group
ABSTRACT. Methods. Retrospective national study of 14 academic tertiary referral rheumatology medical centers. RA patients with a Disease Activity Score (DAS28) > 3.2 were defined as having active disease and could start TNF-a blockers. All patients received one TNF-a blocker plus methotrexate (10–20 mg/wk). At the third month the patients were categorized as responders or nonresponders, based on improvement of at least 0.25 of the Health Assessment Questionnaire (HAQ). Those who had improved by at least 0.25 HAQ were analyzed for possible predictors of DAS28 remission at the sixth month. Results. A total of 1257 patients started TNF-a blockers. Of these, 591 (46.7%) reached the sixth month with an improvement of HAQ of 0.25 at the third month. In the cohort of patients reaching HAQ of 0.25, DAS28 remission was seen in 24% of rheumatoid factor (RF)-positive and 36% of RF-negative patients (p = 0.03). Logistic regression analysis for predictors of remission identified age at baseline, HAQ < 1.63, and RF negativity as positive predictors of remission at 6 months along with sex (male). Conclusion. We show that only a minority of patients with longstanding RA achieve a good clinical response or remission at the outpatient community level. Predictors of remission identify characteristics commonly observed in subsets with less severe RA. (First Release July 1 2007; J Rheumatol 2007;34:1670-3) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From the Division of Rheumatology, Catholic University of the Sacred Heart, Rome; and Rheumatic Disease Units, Universities of Verona, Genova, Modena, Siena, Perugia, Ancona, Bari, Pavia, Firenze, Palermo, Ferrara, Napoli 2, and Rome–La Sapienza, Italy. Supported by Gruppo Italiano Studio Early Arthritis (Italian Study Group for Early Arthritis). L. Mancarella, MD; G.F. Ferraccioli, MD, Professor of Rheumatology, Division of Rheumatology, Catholic University of the Sacred Heart; F. Bobbio-Pallavicini, MD; C. Montecucco, MD, Professor, Rheumatic Disease Unit, IRCCS, University of Pavia; F. Ceccarelli, MD; G. Valesini, MD, Professor, Rheumatic Disease Unit, University of Rome-La Sapienza; P.C. Falappone, MD; G. Lapadula, Professor, MD, Rheumatic Disease Unit, University of Bari; A. Ferrante, MD; G. Triolo, MD, Professor, Rheumatic Disease Unit, University of Palermo; D. Malesci, MD; G. Valentini, MD, Professor, Rheumatic Disease Unit, University of Napoli 2; A. Massara, MD; F. Trotta, MD, Professor, Rheumatic Disease Unit, University of Ferrara; F. Nacci, MD; M. Matucci Cerinic, MD, Professor, Rheumatic Disease Unit, University of Firenze; M.E. Secchi, MD; M. Cutolo, MD, Professor, Rheumatic Disease Unit, University of Genova; S. Manganelli, MD; M. Galeazzi, MD, Professor, Rheumatic Disease Unit, University of Siena; F. Salaffi, MD; W. Grassi, MD, Professor, Rheumatic Disease Unit, University of Ancona; M.L. Bambara, MD, Professor, Rheumatic Disease Unit, University of Verona; S. Bombardieri, MD, Professor; C. Ferri, MD, Rheumatic Disease Unit, University of Modena; R. Gerli, MD, Professor, Rheumatic Disease Unit, University of Perugia; R. Giacomelli, MD, Professor. Address reprint requests to Dr. G.F. Ferraccioli, Catholic University of the Sacred Heart, Association Columbus, Via Moscati 31, 00168, Rome, Italy. E-mail:gf.ferraccioli@rm.unicatt.it Accepted for publication March 24, 2007. |
