Gender, depression and obesity amongst factors that influence remission from inflammatory polyarthritis, a new study has found
A new study, published in Rheumatology, suggests that a range of factors including gender, functional disability, depression and obesity play a big part in a patient’s chance of achieving remission from inflammatory polyarthritis.
Research by Michael Cook et al, at the Centre for Musculoskeletal Research, The University of Manchester, set out to identify factors which predict achieving remission and achieving sustained remission from the condition.
The ultimate aim of treatment in patients with inflammatory polyarthritis, or its subset rheumatoid arthritis, is to achieve early and sustained remission. Remission has the greatest beneficial impact on long-term functional disability, work disability, and joint damage, if it is sustained over a period of time. Current remission rates for patients with IP vary considerably and studies have not followed patients long enough to assess length of remission.
Researchers, supported by the NIHR Manchester Musculoskeletal Biomedical Research Unit and Arthritis Research UK, set out to identify factors measured at an early stage of disease associated with sustained, intermittent or never achieving remission. This was done by analysing clinical and demographic data from patients with IP on the Norfolk Arthritis Register (NOAR; chief investigator, Dr Alex MacGregor, University of East Anglia, Norwich) over a five year period.
Remission was defined as no tender or swollen joints, when evaluated at four different time points. Patients who achieved remission at three or more consecutive time points were classified as achieving persistent remission.
In total, 46% of patients were in remission at least once during the follow up period, and 12% of patients achieved sustained remission.
Researchers found the following factors at baseline were independently associated with a lower probability of achieving remission:
- Female sex (women were around 50% less likely to achieve remission compared to men).
- Higher tender joint count (for each additional tender joint the chance of remission was reduced by 6%).
- Higher HAQ score (for each additional 1.0 increase in Health Assessment Questionnaire (HAQ) the chance of remission was reduced by 41%).
- Being obese (30% less likely to achieve remission that those who were not obese).
- Having high blood pressure (30% less likely to achieve remission than those with normal blood pressure).
- Being depressed (36% less likely to achieve remission than those without depression).
Lead of this study, Dr Suzanne Verstappen, Senior Research Fellow at the Arthritis Research UK Centre for Epidemiology, said: “Gender was the factor most strongly associated with failure to achieve remission; only 5% of women achieved persistent remission, compared to 19% of men. Patients who achieved remission had better functional ability over the study period compared to patients who did not achieve remission.
We have identified a number of factors which predict remission in patients with inflammatory polyarthritis. These factors may be useful in guiding treatment choices and identifying patients for more intensive therapy, which could increase the proportion of patients who achieve persistent remission.
“Our results show that a range of factors influence a patient’s chance of achieving remission. These factors should be taken into account in order to maximise patients’ ability to achieve remission. With the prevalence of obesity rising in the UK and globally, this may become an increasingly important factor in the future.”
