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Clinical predictors of remission and low disease activity in Latin American early rheumatoid arthritis: data from the GLADAR cohort

  • Original Article
  • Published:
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A Correction to this article was published on 20 August 2019

This article has been updated

Abstract

Objectives

To identify baseline predictors of remission and low disease activity (LDA) in early rheumatoid arthritis (RA) from the GLADAR (Grupo Latino Americano De estudio de la Artritis Reumatoide) cohort.

Methods

Patients with 1- and 2-year follow-up visits were included. Remission and LDA were defined by DAS28-ESR (< 2.6 and ≤ 3.2, respectively). Baseline predictors examined were gender, ethnicity, age at diagnosis, socioeconomic status, symptoms’ duration, DMARDs, RF, thrombocytosis, anemia, morning stiffness, DAS28-ESR (and its components), HAQ-DI, DMARDs and corticosteroid use, and Sharp-VDH score. Multivariable binary logistic regression models (excluding DAS28-ESR components to avoid over adjustment) were derived using a backward selection method (α-level set at 0.05).

Results

Four hundred ninety-eight patients were included. Remission and LDA/remission were met by 19.3% and 32.5% at the 1-year visit, respectively. For the 280 patients followed for 2 years, these outcomes were met by 24.3% and 38.9%, respectively. Predictors of remission at 1 year were a lower DAS28-ESR (OR 1.17; CI 1.07–1.27; p = 0.001) and HAQ-DI (OR 1.48; CI 1.04–2.10; p = 0.028). At 2 years, only DAS28-ESR (OR 1.40; CI 1.17–1.6; p < 0.001) was a predictor. Predictors of LDA/remission at 1 year were DAS28-ESR (OR 1.42; CI 1.26–1.61; p < 0.001), non-use of corticosteroid (OR 1.74; CI 1.11–2.44; p = 0.008), and male gender (OR 1.77; CI 1.2–2.63; p = 0.036). A lower baseline DAS28-ESR (OR 1.45; CI 1.23–1.70; p < 0.001) was the only predictor of LDA/remission at 2 years.

Conclusions

A lower disease activity consistently predicted remission and LDA/remission at 1 and 2 years of follow-up in early RA patients from the GLADAR cohort.

Key Points

• In patients with early RA, a lower disease activity at first visit is a strong clinical predictor of achieving remission and LDA subsequently.

• Other clinical predictors of remission and LDA to keep in mind in these patients are male gender, non-use of corticosteroids and low disability at baseline.

• Not using corticosteroids at first visit is associated with a lower disease activity and predicts LDA/remission at 1 year in these patients.

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Change history

  • 20 August 2019

    The original version of this article, unfortunately, contained an error. The first and family name of Loreto Massardo was interchanged and is now presented correctly in this article.

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Acknowledgements

To our patients who graciously agreed to participate in this study.

Funding

The GLADAR cohort was supported by an unrestricted educational grant from Abbott Laboratories.

Author information

Authors and Affiliations

  1. Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Av. Miguel Grau 800, La Victoria, 15033, Lima, Peru

    Rocio V Gamboa-Cárdenas & Manuel F. Ugarte-Gil

  2. Universidad Científica del Sur, Lima, Peru

    Manuel F. Ugarte-Gil

  3. Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile

    Massardo Loreto

  4. Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina

    Mónica P. Sacnun & Bernardo A. Pons-Estel

  5. Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina

    Verónica Saurit

  6. Centro de Investigación Clínica de Morelia, Morelia, Mexico

    Mario H. Cardiel

  7. Sección Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Enrique R. Soriano

  8. Sección de Inmunología y Reumatología, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina

    Cecilia Pisoni

  9. Unidad de Enfermedades Reumáticas y Autoinmunes (UNERA), Corporación Médica Monte Sinaí, Cuenca, Ecuador

    Claudio M. Galarza-Maldonado

  10. Centro de Reumatología y Rehabilitación, Universidad Espíritu Santo, Guayaquil, Ecuador

    Carlos Rios

  11. Serviço de Reumatologia, Hospital de Clinicas da Universidade Federal do Paraná, Curitiba, Brazil

    Sebastião C. Radominski

  12. Disciplina de Reumatologia, Departamento de Medicina Interna, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

    Geraldo da R. Castelar-Pinheiro

  13. Serviço de Reumatologia do Hospital General da Santa Casa da Misericórdia do Rio de Janeiro, Faculdade de Medicina da Universidade Estácio de Sá, Departamento de Medicina Interna da Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

    Washington Alves Bianchi

  14. Rheumatology Unit School of Medical Science, University of Campinas, Campinas, Brazil

    Simone Appenzeller

  15. Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Inés Guimarães da Silveira

  16. Centro Paulista de Investigación Clínica, São Paulo, Brazil

    Cristiano A. de Freitas Zerbini

  17. Servicio de Reumatología, Hospital Universidad del Norte, Barranquilla, Colombia

    Carlo V. Caballero-Uribe

  18. Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia

    Adriana Rojas-Villarraga

  19. Servicio de Reumatología, Hospital Clínico Quirúrgico Diez de Octubre, Havana, Cuba

    Marlene Guibert-Toledano

  20. Servicio de Reumatología, Hospital Clínico San Borja-Arriaran, Santiago de Chile, Chile

    Francisco Ballesteros

  21. Departamento de Reumatología, Consultorio de Especialidades del Instituto Salvadoreño de Seguro Social, San Salvador, El Salvador

    Rubén Montufar

  22. Servicio de Reumatología, Hospital General de México, Ciudad de México, Mexico

    Janitzia Vázquez-Mellado

  23. Servicio de Reumatología, Hospital Universitario “Dr. José Eleuterio Gonzalez”, Monterrey, Mexico

    Jorge Esquivel-Valerio

  24. Departamento de Inmunología y Reumatología, Hospital General de Occidente, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

    Ignacio García De La Torre

  25. Servicio de Reumatología, Hospital Ángeles del Pedregal, Ciudad de México, Mexico

    Leonor A. Barile-Fabris

  26. Servicio de Reumatología, Centro Médico Nacional 20 de Noviembre, Ciudad de México, Mexico

    Fedra Irazoque Palezuelos & Lilia Andrade-Ortega

  27. Hospital México, Caja Costarricense de Seguro Social, Universidad de Costa Rica, San José, Costa Rica

    Pablo Monge

  28. Médica Uruguaya Corporación de Asistencia Médica (MUCAM), Montevideo, Uruguay

    Raquel Teijeiro

  29. Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid, Caja de Seguro Social de Panamá, Panama City, Panama

    Ángel F. Achurra-Castillo

  30. Servicio de Reumatología, Departamento de Medicina, Hospital Central de San Cristóbal, San Cristóbal, Venezuela

    María H. Esteva Spinetti

  31. Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA

    Graciela S. Alarcón

  32. Departamento de Medicina Interna, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño, Rosario, Argentina

    Bernardo A. Pons-Estel

Authors
  1. Rocio V Gamboa-Cárdenas
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  2. Manuel F. Ugarte-Gil
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  25. Leonor A. Barile-Fabris
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  30. Ángel F. Achurra-Castillo
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  31. María H. Esteva Spinetti
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  32. Graciela S. Alarcón
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  33. Bernardo A. Pons-Estel
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Correspondence to Rocio V Gamboa-Cárdenas.

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Gamboa-Cárdenas, R.V., Ugarte-Gil, M.F., Loreto, M. et al. Clinical predictors of remission and low disease activity in Latin American early rheumatoid arthritis: data from the GLADAR cohort. Clin Rheumatol 38, 2737–2746 (2019). https://doi.org/10.1007/s10067-019-04618-x

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  • DOI: https://doi.org/10.1007/s10067-019-04618-x

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