Effect of Treat-to-target Strategies Aiming at Remission of Arterial Stiffness in Early Rheumatoid Arthritis: A Randomized Controlled Study
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AbstractOBJECTIVE:
To determine the efficacy of 2 tight control treatment strategies aiming at Simplified Disease Activity Score (SDAI) remission (SDAI ≤ 3.3) compared to 28-joint count Disease Activity Score (DAS28) remission (DAS28 < 2.6) in the prevention of arterial stiffness in patients with early rheumatoid arthritis (RA).

METHODS:
This was an open-label study in which 120 patients with early RA were randomized to receive 1 year of tight control treatment. Group 1 (n = 60) aimed to achieve SDAI ≤ 3.3 and Group 2 (n = 60), DAS28 < 2.6. Pulse wave velocity (PWV) and augmentation index (AIx) were measured at baseline and 12 months. A posthoc analysis was also performed to ascertain whether achieving sustained remission could prevent progression in arterial stiffness.

RESULTS:
The proportions of patients receiving methotrexate monotherapy were significantly lower in Group 1 throughout the study period. At 12 months, the proportions of patients achieving DAS28 and SDAI remission, and the change in PWV and AIx, were comparable between the 2 groups. In view of the lack of differences between the 2 groups, a posthoc analysis was performed at Month 12, including all 110 patients with PWV, to elucidate the independent predictors associated with the change in PWV. Multivariate analysis revealed that achieving sustained DAS28 remission at months 6, 9, and 12 and a shorter disease duration were independent explanatory variables associated with less progression of PWV.

CONCLUSION:
With limited access to biologic disease-modifying antirheumatic drugs, treatment efforts toward DAS28 and SDAI remission had similar effects in preventing the progression of arterial stiffness at 1 year. However, achieving sustained DAS28 remission was associated with a significantly greater improvement in PWV.
Acceptance Date15/05/2018
All Author(s) ListLydia Ho-Pui Tam, Qing Shang, Edmund Kwok-Ming Li, Priscilla Ching-Han Wong, Kitty Yan Kwok, Emily Wai-Lin Kun, Isaac Cheuk-Wan Yim, Violet Ka-Lai Lee, Ronald Man-Lung Yip, Steve Hin-Ting Pang, Virginia Weng-Nga Lao, Queenie Wah-Yan Mak, Isaac Tsz-Ho Cheng, Xerox Sze-Lok Lau, Tena Ka-Yan Li, Tracy Yaner Zhu, Alex Pui-Wai Lee, Lai-Shan Tam
Journal nameJournal of Rheumatology
Year2018
Month9
Day1
Volume Number45
Issue Number9
Pages1229 - 1239
ISSN0315-162X
eISSN1499-2752
LanguagesEnglish-United Kingdom
KeywordsEARLY RHEUMATOID ARTHRITIS, ARTERIAL STIFFNESS, PULSE WAVE VELOCITY, AUGMENTATION INDEX, REMISSION

Last updated on 2021-20-09 at 23:59