Baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial

Arthritis Research & Therapy

Fowzia Ibrahim¹  David L. Scott¹  Elena Nikiphorou¹  Heidi Lempp¹  Sook Yan Lee¹  Brian D. M. Tom²  Frances M. K. Williams³ 

[1] Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, Cutcombe Road, SE5 9RJ, London, UK;MRC Biostatistics Unit, University of Cambridge, East Forvie Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, CB2 0SR, Cambridge, UK;Twin Research & Genetic Epidemiology, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, SE1 7EH, London, UK;

关键词: Anxiety;    Depression;    Disease activity score;    Fatigue;    Intensive management;    Obesity;    Pain;    Rheumatoid arthritis;   

DOI  :  10.1186/s13075-021-02653-1

来源: Springer

【 摘 要 】

BackgroundClinical trials show intensive treatment to induce remission is effective in patients with highly active rheumatoid arthritis (RA). The TITRATE trial showed that the benefits of intensive treatment also extend to moderately active RA. However, many patients failed to achieve remission or show improvements in pain and fatigue. We investigated whether baseline predictors could identify treatment non-responders.MethodsThe impact of obesity, depression, anxiety and illness perception on RA outcomes, including disease activity, remission, pain and fatigue were determined using a pre-planned secondary analysis of the TITRATE trial data.ResultsBody mass index was associated with disease activity levels and remission: obese patients had a higher overall disease activity and fewer obese patients achieved remission. Intensive management was not associated with increased remission in these patients. Obesity was also associated with increased overall pain and fatigue. Anxiety, depression and health perceptions had no discernible impact on disease activity but were associated with high levels of pain and fatigue. There was a strong association between anxiety and high pain scores; and between depression and high fatigue scores; and health perception was strongly related to both. None of the predictors had an important impact on pain and fatigue reduction in cross-sectional analysis.ConclusionsDisease activity is higher in obese patients and they have fewer remissions over 12 months. Anxiety, depression and health perceptions were associated with higher pain and fatigue scores. Intensive management strategies need to account for these baseline features as they impact significantly on clinical and psychological outcomes.Trial registrationISRCTN 70160382; date registered 16 January 2014

【 授权许可】

CC BY