Prevalence and Predictors of Remission and Sustained Remission in Patients with Rheumatoid Arthritis from the United Arab Emirates: A Two-Year Prospective Study

Abstract

Aim

To estimate the prevalence of remission and sustained remission for more than 12 months in a cohort of patients with rheumatoid arthritis in the United Arab Emirates and explore predictors of remission and sustained remission in these patients.

Methods

A two-year prospective study conducted in Dubai Hospital (January 1, 2018-December 31, 2019) included all consecutive patients with rheumatoid arthritis attending the rheumatology clinic. Patients with a Simplified Disease Activity Index ≤3.3 and/or Clinical Disease Activity Index ≤2.8 in December 2018 were considered in remission and followed until December 2019. Those who maintained remission through 2019 were considered in sustained remission.

Results

In this study, a total of 444 patients were followed for a 12-months period. The percentage of remission achieved in RA patients was 30.4% according to the Clinical Disease Activity Index, 31.1% according to Simplified Disease Activity Index, and 50.9% according to the Value of Disease Activity Score 28 (DAS28) remission criteria. The 12-months sustained remission rates ranged from 38.3% for the ACR-EULAR to 69.3% for the DAS28. Male gender, shorter disease duration, better functioning as evaluated by the Health Assessment Questionnaire Disability Index (lower HAQ scores), and higher compliance rates are among sustained remission predictors.

Conclusion

Establishing “real-world” data and understanding local predictors to sustained remission is principal for implementing timely and appropriate patient-tailored strategies. These strategies include early detection, close monitoring, and enhancing treatment adherence among UAE patients.

Keywords:

• predictors
• remission
• rheumatoid arthritis
• sustained remission
• United Arab Emirates

Abbreviations

ACR, American College of Rheumatology; ACPA, Anti-Citrullinated Protein/Peptide Antibody; ASCVD, Atherosclerotic Cardiovascular Disease; CRP, C-Reactive Protein; CCI, Charlsons’ Comorbidities Index; CDAI, Clinical Disease Activity Index; CI, Confidence interval; DAS28, Disease Activity Score 28; ESR, Erythrocyte Sedimentation Rate; EULAR, European League Against Rheumatism; HAQ, Health Assessment Questionnaire Disability Index; IQR, Interquartile Range; LDA, Low Disease Activity; RR, Relative Risk; RA, Rheumatoid Arthritis; RF, Rheumatoid Factor; SDAI, Simplified Disease Activity Index; T2T, Treat-to-Target; UAE, United Arab Emirates.

Data Sharing Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethical Approval

This work has been performed in accordance with the ethical standards of the Declaration of Helsinki. The study received the Institutional Review Board (IRB) from the Dubai Scientific Research Ethics Committee (DSREC), Dubai Health Authority (ethics committee number: DSREC-11/2018.04), and all patients signed written informed consent for data collection and research use.

Acknowledgments

The authors would like to thank the Emirates Society for Rheumatology for supporting this work, and Science PRO sarl for conducting critical review and editing of the article.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare they have no conflicts of interest.