Baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial.
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Authors
Ibrahim, Fowzia
Nikiphorou, Elena
Williams, Frances MK
Lempp, Heidi
Scott, David L
Publication Date
2021-11-04Journal Title
Arthritis Res Ther
ISSN
1478-6354
Publisher
Springer Science and Business Media LLC
Volume
23
Issue
1
Language
eng
Type
Article
This Version
VoR
Metadata
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Lee, S. Y., Ibrahim, F., Tom, B., Nikiphorou, E., Williams, F. M., Lempp, H., & Scott, D. L. (2021). Baseline predictors of remission, pain and fatigue in rheumatoid arthritis: the TITRATE trial.. Arthritis Res Ther, 23 (1) https://doi.org/10.1186/s13075-021-02653-1
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.
Keywords
Obesity, Rheumatoid arthritis, Depression, Pain, Fatigue, Anxiety, Disease Activity Score, Intensive Management, Humans, Arthritis, Rheumatoid, Antirheumatic Agents, Severity of Illness Index, Cross-Sectional Studies
Sponsorship
National Institute for Health Research (NIHR) (RP-PG-0610-10066)
Medical Research Council (MC_UP_1302/3, MRC_MC_UU_00002/2)
Identifiers
PMC8567573, 34736525
External DOI: https://doi.org/10.1186/s13075-021-02653-1
This record's URL: https://www.repository.cam.ac.uk/handle/1810/332208
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