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

Abstract Background Clinical 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 remi...

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Autores principales:	Sook Yan Lee, Fowzia Ibrahim, Brian D. M. Tom, Elena Nikiphorou, Frances M. K. Williams, Heidi Lempp, David L. Scott
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Anxiety Depression Disease activity score Fatigue Intensive management Obesity Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/0ebf5cdfa430431e922860b4616292ce
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spelling	oai:doaj.org-article:0ebf5cdfa430431e922860b4616292ce2021-11-07T12:05:46ZBaseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial10.1186/s13075-021-02653-11478-6362https://doaj.org/article/0ebf5cdfa430431e922860b4616292ce2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13075-021-02653-1https://doaj.org/toc/1478-6362Abstract Background Clinical 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. Methods The 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. Results Body 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. Conclusions Disease 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 registration ISRCTN 70160382 ; date registered 16 January 2014Sook Yan LeeFowzia IbrahimBrian D. M. TomElena NikiphorouFrances M. K. WilliamsHeidi LemppDavid L. ScottBMCarticleAnxietyDepressionDisease activity scoreFatigueIntensive managementObesityDiseases of the musculoskeletal systemRC925-935ENArthritis Research & Therapy, Vol 23, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Anxiety Depression Disease activity score Fatigue Intensive management Obesity Diseases of the musculoskeletal system RC925-935
spellingShingle	Anxiety Depression Disease activity score Fatigue Intensive management Obesity Diseases of the musculoskeletal system RC925-935 Sook Yan Lee Fowzia Ibrahim Brian D. M. Tom Elena Nikiphorou Frances M. K. Williams Heidi Lempp David L. Scott Baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial
description	Abstract Background Clinical 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. Methods The 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. Results Body 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. Conclusions Disease 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 registration ISRCTN 70160382 ; date registered 16 January 2014
format	article
author	Sook Yan Lee Fowzia Ibrahim Brian D. M. Tom Elena Nikiphorou Frances M. K. Williams Heidi Lempp David L. Scott
author_facet	Sook Yan Lee Fowzia Ibrahim Brian D. M. Tom Elena Nikiphorou Frances M. K. Williams Heidi Lempp David L. Scott
author_sort	Sook Yan Lee
title	Baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial
title_short	Baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial
title_full	Baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial
title_fullStr	Baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial
title_full_unstemmed	Baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial
title_sort	baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the titrate trial
publisher	BMC
publishDate	2021
url	https://doaj.org/article/0ebf5cdfa430431e922860b4616292ce
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Baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial

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