OUTCOME OF RHEUMATOID ARTHRITIS IN INDIAN PATIENTS: A RETROSPECTIVE STUDY

Dr. Tukaram C Ahirawadagi; Dr Anuj Singhal; Dr SK Joshi; Dr Rahul Tyagi

Volume : VII, Issue : IX, September - 2017

OUTCOME OF RHEUMATOID ARTHRITIS IN INDIAN PATIENTS: A RETROSPECTIVE STUDY

Dr. Tukaram C Ahirawadagi, Dr Anuj Singhal, Dr Sk Joshi, Dr Rahul Tyagi

Abstract :

Background and objective: Rheumatoid arthritis (RA) is a major burden in India. Factors determining remission have been studied in Western population but not in India. Hence, the objective was to find out the factors determining low disease activity (Disease activity Score 28 erythrocyte sedimentation score (DAS28) and the efficacy of biologics alone or as add on in RA patients.

Materials and methods: This was a descriptive study from a single centre, tertiary care hospital carried out in South Mumbai, India. Data was analyzed retrospectively between January 2014– June 2016 from hospital medical records department, lab records department, Outpatient department (OPD) register and pharmacy records. Patients with RA as per American college of Rheumatology (ACR) criteria were enrolled into the study.

DMARD failure patients were put on methotrexate (MTX) treatment along with Biologic response modifier (BRM) to or switched to another BRM. To monitor disease activity, DAS28 was obtained at baseline, and after three months and six months of therapy initiation. To predict the factors that would determine outcomes defined by DAS28<3.5 at six months, logistic regression was applied.

Results: A total of 135 RA patients with mean age of 44 years were subjected to either; MTX+ Hydroxychloroquine (HCQ) (n=73) or MTX+ Leflunomide (LEFT) (n=22) or HCQ/LEFT combination n=2, either LEFT or HCQ n=91 or MTX+ BRM (n=51) or MTX+ 2^nd BRM (n=23). The mean duration of treatment was five months. The Rheumatoid factor (RF) titre values were positive for 90 patients and negative for 45 patients. The Anti–cyclic citrullinated peptide antibody (anti–CCP) titre values were positive for 86 patients and negative for 26 patients.

Initial DAS28 was 4.10±1.13 (mean ± standard deviation (SD)) which reduced to 3.58±0.98 at three months of treatment and further reduced to 3.11±0.69 at six months of treatment. About 48.1% and 70.4% of patients attained remission at three months and six months of treatment, respectively.

Patients who have received the biological treatment had statistically significant logistic regression, odds ratio of 2.77 (1.0, 7.62, 95% Confidence Interval (CI)) or approximately three times more pain relief as compared no biologic treatment. The data on regression of patients who were shifted from BRM to another BRM was poor due to less sample size for each biologic. Patients with remission at baseline (DAS28), had a lower chance of pain relief, 0.24 compared to who did not have remission, which was statistically significant.

Conclusion: Lower disease activity at baseline and use of BMRs were predictors of better outcomes in terms of DAS28 score at the end of six months. Patients with female sex, longer duration of illness and positive ACPAb were statistically found to have higher disease activity. Patients who did not respond to combination DMARD or first line BRM are less likely to respond to second BRM, although more study is required in this field.