Effect of Treat-to-target Strategies Aiming at Remission of Arterial Stiffness in Early Rheumatoid Arthritis: A Randomized Controlled Study.
OBJECTIVE
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. [Clinical Trial registration: Clinicaltrial.gov NCT01768923.].
['Tam|Lydia Ho-Pui|LH|', 'Shang|Qing|Q|', 'Li|Edmund Kwok-Ming|EK|', 'Wong|Priscilla Ching-Han|PC|', 'Kwok|Kitty Yan|KY|', 'Kun|Emily Wai-Lin|EW|', 'Yim|Isaac Cheuk-Wan|IC|', 'Lee|Violet Ka-Lai|VK|', 'Yip|Ronald Man-Lung|RM|', 'Pang|Steve Hin-Ting|SH|', 'Lao|Virginia Weng-Nga|VW|', 'Mak|Queenie Wah-Yan|QW|', 'Cheng|Isaac Tsz-Ho|IT|', 'Lau|Xerox Sze-Lok|XS|', 'Li|Tena Ka-Yan|TK|', 'Zhu|Tracy Yaner|TY|', 'Lee|Alex Pui-Wai|AP|', 'Tam|Lai-Shan|LS|']
D000328:Adult D000368:Aged D018501:Antirheumatic Agents D001172:Arthritis, Rheumatoid D018450:Disease Progression D005260:Female D006801:Humans D008297:Male D008727:Methotrexate D008875:Middle Aged D063177:Pulse Wave Analysis D012074:Remission Induction D012720:Severity of Illness Index D016896:Treatment Outcome D059289:Vascular Stiffness
REMISSION ARTERIAL STIFFNESS EARLY RHEUMATOID ARTHRITIS PULSE WAVE VELOCITY AUGMENTATION INDEX