Brief Report
Prognostic Factors for Sustained Remission in a “Real Life” Cohort of Rheumatoid Arthritis Patients
Factores pronósticos para la remisión sostenida en una cohorte de “vida real” de pacientes con artritis reumatoide
Leído
3781
Vecesse ha leído el artículo
1655
Total PDF
2126
Total HTML
Compartir estadísticas
array:23 [ "pii" => "S1699258X18302316" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2018.10.002" "estado" => "S300" "fechaPublicacion" => "2020-09-01" "aid" => "1287" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2020;16:405-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5 "formatos" => array:2 [ "HTML" => 3 "PDF" => 2 ] ] "itemSiguiente" => array:18 [ "pii" => "S1699258X18301852" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2018.08.005" "estado" => "S300" "fechaPublicacion" => "2020-09-01" "aid" => "1267" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2020;16:410-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 251 "formatos" => array:3 [ "EPUB" => 16 "HTML" => 175 "PDF" => 60 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Gota tofácea en la columna lumbar causando radiculopatía" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "410" "paginaFinal" => "412" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Tophaceous Gout in the Lumbar Spine Causing Radiculopathy" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2132 "Ancho" => 2833 "Tamanyo" => 515944 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A) Imagen de doble contorno del cartílago femoral (flechas). B) Quiste de Baker de paredes gruesas (círculo) con puntilleo hiperecoico en su interior (cabezas de flechas). C) Material amorfo anfófilo acelular (estrella) bordeado por histiocitos epitelioides (doble flecha) y células gigantes multinucleadas (flecha) que fagocitan este material.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carolina Duarte-Salazar, Norma Marín-Arriaga, Lucio Ventura-Ríos, Armando Alpízar-Aguirre, Raúl Pichardo-Bahena, Aurelia Arellano Hernández" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Carolina" "apellidos" => "Duarte-Salazar" ] 1 => array:2 [ "nombre" => "Norma" "apellidos" => "Marín-Arriaga" ] 2 => array:2 [ "nombre" => "Lucio" "apellidos" => "Ventura-Ríos" ] 3 => array:2 [ "nombre" => "Armando" "apellidos" => "Alpízar-Aguirre" ] 4 => array:2 [ "nombre" => "Raúl" "apellidos" => "Pichardo-Bahena" ] 5 => array:2 [ "nombre" => "Aurelia" "apellidos" => "Arellano Hernández" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574319301273" "doi" => "10.1016/j.reumae.2018.08.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301273?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X18301852?idApp=UINPBA00004M" "url" => "/1699258X/00000016000005P2/v1_202009230737/S1699258X18301852/v1_202009230737/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1699258X1830189X" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2018.08.009" "estado" => "S300" "fechaPublicacion" => "2020-09-01" "aid" => "1271" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2020;16:396-404" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 42 "formatos" => array:2 [ "HTML" => 32 "PDF" => 10 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Seguridad y supervivencia de las terapias biológicas: primer informe del registro paraguayo-uruguayo de acontecimientos adversos con terapias biológicas Biobadaguay" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "396" "paginaFinal" => "404" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Safety and Survival Associated with Biologic Therapies: First Report of the Biobadaguay on the Paraguayan-Uruguayan Registry of Adverse Events with Biologic Therapies" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2155 "Ancho" => 2181 "Tamanyo" => 392896 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Incidencia en función de línea de tratamiento y tipo de acontecimiento adverso.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paloma de Abreu, Gabriela Ávila-Pedretti, Zoilo Morel, María Isabel Acosta, Sonia Cabrera-Villalba, Patricia Melgarejo, Marco Franco, Pedro Delgadillo, Lourdes Román, Juan Gabriel Elizaur, Ernesto Paredes, Darwin Octavio Cordovilla, Daniel Palleiro, Miguel Albanese, Julio Mazzoleni" "autores" => array:15 [ 0 => array:2 [ "nombre" => "Paloma" "apellidos" => "de Abreu" ] 1 => array:2 [ "nombre" => "Gabriela" "apellidos" => "Ávila-Pedretti" ] 2 => array:2 [ "nombre" => "Zoilo" "apellidos" => "Morel" ] 3 => array:2 [ "nombre" => "María Isabel" "apellidos" => "Acosta" ] 4 => array:2 [ "nombre" => "Sonia" "apellidos" => "Cabrera-Villalba" ] 5 => array:2 [ "nombre" => "Patricia" "apellidos" => "Melgarejo" ] 6 => array:2 [ "nombre" => "Marco" "apellidos" => "Franco" ] 7 => array:2 [ "nombre" => "Pedro" "apellidos" => "Delgadillo" ] 8 => array:2 [ "nombre" => "Lourdes" "apellidos" => "Román" ] 9 => array:2 [ "nombre" => "Juan Gabriel" "apellidos" => "Elizaur" ] 10 => array:2 [ "nombre" => "Ernesto" "apellidos" => "Paredes" ] 11 => array:2 [ "nombre" => "Darwin Octavio" "apellidos" => "Cordovilla" ] 12 => array:2 [ "nombre" => "Daniel" "apellidos" => "Palleiro" ] 13 => array:2 [ "nombre" => "Miguel" "apellidos" => "Albanese" ] 14 => array:2 [ "nombre" => "Julio" "apellidos" => "Mazzoleni" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574320301040" "doi" => "10.1016/j.reumae.2018.08.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320301040?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1830189X?idApp=UINPBA00004M" "url" => "/1699258X/00000016000005P2/v1_202009230737/S1699258X1830189X/v1_202009230737/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief Report</span>" "titulo" => "Prognostic Factors for Sustained Remission in a “Real Life” Cohort of Rheumatoid Arthritis Patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "405" "paginaFinal" => "409" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ángeles Acosta-Mérida, Antonio Naranjo, Carlos Rodríguez-Lozano" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Ángeles" "apellidos" => "Acosta-Mérida" "email" => array:1 [ 0 => "angyacostamerida@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Antonio" "apellidos" => "Naranjo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Carlos" "apellidos" => "Rodríguez-Lozano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospitales San Roque, Las Palmas De Gran Canaria, 35001, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario de Gran Canaria Dr. Negrín, Rheumatology Department, Las Palmas de Gran Canaria, Las Palmas 35011, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores pronósticos para la remisión sostenida en una cohorte de “vida real” de pacientes con artritis reumatoide" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis (RA) is the most frequent chronic inflammatory disease, affecting 0.5%–1% of the European and North American population. Its prevalence in Spain and in the Canary Islands is 0.5%.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> RA is characterized by persistent joint inflammation associated with further joint damage and disability. Not only the development of new drugs, but also the early diagnosis and treatment, provides better control of the disease and better long-term prognosis. The goal of RA treatment of the lowest disease activity possible has improved the results compared to the classic management. The <span class="elsevierStyleItalic">treat to target</span> strategy has a goal defined as clinical remission or low disease activity. The evaluation scales and their remission criteria have been in continuous revision, because depending on the index that is being used, patients with the same activity may obtain different punctuations. The purpose of this study was to determine the prevalence of clinical remission in a “real life” cohort of RA patients and identify factors associated with clinical remission, since knowing modifiable factors associated with remission could help achieve clinical outcomes.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0010" class="elsevierStylePara elsevierViewall">Data was collected from 463 patients. It was an observational, retrospective, realworld cohort of patients with RA recruited at the Rheumatology division of the HUGCDN since the first of January 2000 until the thirteenth of April 2014. Inclusion criteria were patients older than 18 years, diagnosed RA according to 2010 ACR/EULAR classification criteria and with available follow-up data of a minimum of two years after the basal visit.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Measures and Data Collection</span><p id="par0015" class="elsevierStylePara elsevierViewall">There were patients referred by the primary care doctor to the Hospital, patients from the emergency department or referred by other hospital units. Data was collected between January 2013 and April 2014. The baseline characteristics, included sex, age, history of smoking and alcohol intake and medical comorbidities (osteoporosis, hypertension, ischemic heart disease, heart failure, infarct, chronic obstructive pulmonary disease, asthma, depression and diabetes). Clinical data of RA: 28 and 44 joint counts, general health and pain in visual analog scale (VAS) and morning stiffness. Patients completed the health assessment questionnaire disability index (HAQ-DI). Blood tests that included erythrocyte sedimentation rate (ESR), C reactive protein (CRP), hemoglobin levels and serology including rheumatoid factor (RF) and anti cyclic citrullinated peptide antibody (ACPA) level. 28 count disease activity scores (DAS28) index was calculated. Baseline hand and foot radiographic findings and previous and current treatments were also collected. All data was collected from outpatient medical records. Serum RF was measured by a quantitative immunoturbidimetric assay, and the positive results were defined as a value of more than 14<span class="elsevierStyleMonospace">Y</span>IU/ml. Laboratory test for ACPA level measurement has been introduced into HUGCDN since 2007, so some patients diagnosed RA before that time never took this blood test. The significant changes of radiographic findings included narrowing of joint space or erosions compatible with RA, which were reported in medical records by the rheumatologists or reported by radiologists. In the follow-up visits, 28 and 44 joint counts, VAS GH, VAS pain and morning stiffness, blood tests that included hemoglobin, ESR, CRP and annual hand and foot X-rays were parameters also collected. Incidental comorbidities, and current and new treatments were noted. Disease activity was assessed from DAS28 which was calculated using the original formula with 28 swollen joint count, 28 tender joint count, ESR and VAS GH. Clinical sustained remission was defined as DAS28<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>2.6 in the last two consecutive visits. Low, moderate, and high disease activity states were defined as DAS28<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>3.2, >3.2 but ≤5.1 and >5.1, respectively. The improvement criteria used in this study was the EULAR response criteria. The good responders were patients who had a decline of DAS28 at least 1.2 units from baseline and low disease activity. Moderate responders were patients with a change ≥1.2 and moderate/high disease activity or patients with a change ≤1.2 and >0.6 and low/moderate disease activity, others were nonresponders.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical Analysis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using SPSS V.16.0 statistical software. Baseline characteristics with continuous data were reported as means<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation (SD), and the categorical data was shown as frequencies and percentages. To test the differences between groups, the Mann–Whitney <span class="elsevierStyleItalic">U</span> test or the independent samples <span class="elsevierStyleItalic">t</span> test was used for continuous variables, and the <span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup">2</span> test for proportions. A stepwise multiple logistic regression model was used to find relevant independent prognostic variables. The variables included in the multivariate model were selected using univariate analysis (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05). The results were presented as the odds ratio (OR) with corresponding 95% confidence interval (95% CIs).</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">Four hundred and sixty-three RA patients were included. Baseline characteristics of the whole cohort of patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>463) are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. 75% of patients were female and mean age at diagnosis was 51 years. Mean disease duration was 8 years and mean follow-up time was 5.8 years. Most of the patients were positive RF and ACPA. Almost half of the patients had erosions in X-rays. The most frequent comorbidities were HTA (31%), dislypidemia (25%) and osteoporosis (14%). History of smoking was recorded in 49 patients and there were 77 current smokers. Regarding to extraarticular manifestations, 38 patients had rheumatoid nodules and 14 secondary Sjögren Syndrome. More than 70% of the patients were in moderate/high disease activity in the first visit. Mean DAS28 value was 4.7. At first visit, 5% of the patients were in clinical remission using DAS28. 96% of the patients received synthetic disease modifying antirheumatic drugs (DMARDs) and 23% received biologic synthetic disease modifying antirheumatic drugs (DMARDb). 72% of the patients achieved remission in unless one visit and 214 patients achieved sustained remission (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The univariate analysis showed an association between being in sustained remission and the following baseline variables: male sex, early diagnosis (during the first year of the disease), pain VAS, HAQ, DAS28 score, ESR, good EULAR response to the first treatment, remission during the first year and either DMARDb or DMARDs in monotherapy (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Multiple logistic regression analyses found male sex (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.031, OR 1.7, 95% CI 1.05–2.82), diagnosis in the first year of symptoms (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.023, OR 1.7, 95% CI 1.07–2.69) and the initial DAS28 (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.035) to be independent predictors for sustained remission (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">RA is a chronic inflammatory disease that may cause joint destruction, functional disability and a reduction of the patient's quality of life. Unfortunately, there is no curative treatment for the disease, that is why the real goal is to release inflammation to achieve remission.</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Cohort Characteristics</span><p id="par0045" class="elsevierStylePara elsevierViewall">75% of our patients were women and the mean age at the analysis was 58 years. Almost 80% were RF (+) and 73% ACPA (+), these are similar characteristics to other large cohorts of RA like QEST-RA<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a> with more than 5000 patients, 79% female and a mean age of 57 years or CORRONA<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> cohort with more than 10,000 patients, 76% women with a mean age of 53 years and 78% RF (+).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding disease activity, there is a big variability depending on the research consulted because of the use of different criteria to define the activity of the disease. In our study, the medium value of DAS28 at basal visit was 4.7 and the VAS pain 63 points. In the database BARFOT that included 698 patients, the average of VAS pain was 46 points and the medium value of DAS28 was 5.2.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> In our research, 84% of the patients had DMARDs treatment and 22% DMARDb therapy; comparable data with other seria of patients like the French cohort ESPOIR with 532 patients, 90% with DMARDs therapy and 23% with biological therapy<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a>; or TARACT cohort with 335 patients, where 89% had DMARDs and 10% DMARDb.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Talking about remission, in this study the prevalence of remission using DAS28 in the first visit was 5%, 11% achieve remission during the first year of treatment and 72% had remission at some point during the follow-up. A considerable number of research about prognostic factors of remission in RA show different results due to the heterogenicity of the patients studied, the different definitions of remission and the treatments used. It has been observed prevalences of remission from less than 10% to up to 40%,<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2,5</span></a> although the studies that find higher percentages of remission are those that include early RA. The remission criteria in RA are in continuous discussion because, depending on the tool we use, patients with the same activity have different scores. In fact, in a study of the QUEST-RA cohort,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a> where they evaluated the prevalence of remission using different criteria, they found a great variability (8.6% using ACR and 19.6% using DAS28), concluding that using different criteria results in obtaining different percentages of remission in patients with the same disease activity.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Prognostic Factors of Sustained Remission</span><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding sustained remission, the prevalence of sustained remission in our study was 46%. We did not find any relation between age and disease duration and clinical remission in RA; which has been published in other studies.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">1st suggestion → In the univariate analysis we did not find a relation between the age and the sustained remission. There were more patients achieving remission in the group of younger than 50 years old (58%) than in those patients older than 50 years old (49%) but this finding was not statistically significant. The duration of the disease was shorter in those patients that were in remission than in those who were not in remission but there were no statistically significant association. There were no statistically significant relation between sustained remission and disease duration categorized in less than 5 years, 5–10 years or more than 10 years.</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Male sex</span> was identified as an independent prognostic factor of remission in the multivariate analysis; association that has been communicated before.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> Men had approximately twice the probability of achieving remission than women. Male sex has been related to remission in previous studies like the one with CORRONA cohort with more than 10,000 patients where they used as remission criteria CDAI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>2.8.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> Also, in the study with the French cohort BARFOT, male sex has been identified as independent prognostic factor of remission (OR 1.5) using DAS28 in the last two consecutives visits as sustained remission definition.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> Finally, in the GISEA study with 1257 patients treated with DMARDb, it was found male sex as predictor factor of remission.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Early Diagnosis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Half of the patients in the Rheumatology Division HUGCDN were attended in the first six months after the onset of symptoms which had a relation with the probability of achieving remission either at any point during the follow-up or sustained remission. Early diagnosis in the first year was identified as an independent prognostic factor of maintained remission. So, this is one of the modifiable predictor factors to take into account in the management of a Rheumatology Service in order to achieve the therapeutic goals in RA. The evaluation of a specialist and the early diagnosis since the onset of symptoms will speed up the implementation of adequate treatment and will increase the patient's chances of remission. In this study, the data were variable because there were patients who were on follow up since 2000 up until 2013. Due to the improvement of derivation of patients from primary care and from other Hospital divisions, the delay has been shortened optimizing early diagnosis, although the results could be better. Early diagnosis has been related to remission in other studies such us TARACT,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> a retrospective research in which the definition of sustained remission was remission using DAS28 in two consecutive visits within three months.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">RA Activity in the First Visit</span><p id="par0080" class="elsevierStylePara elsevierViewall">In this study, it has been observed that the RA activity in the first visit will predict the prognosis of the disease. The medium DAS28 punctuation of our cohort of patients was 4.7 and more than 75% of the patients presented moderate to high RA activity at the beginning. DAS28 score was identify as an independent predictive factor of sustained remission in the multivariable analysis, and that has been observed in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6,10</span></a> Low baseline DAS28 was strongly predictive of the achievement of remission, which has been reported in other researches.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3,11</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A lower VAS pain score in the first visit was associated with remission during the first year of treatment, with remission in any point during the follow up and with maintained remission. Vázquez et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> also found a relation between low VAS pain at the beginning and sustained remission.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Functional Capacity</span><p id="par0090" class="elsevierStylePara elsevierViewall">Functional disability will also predict the course of the disease. As seen in previous studies,<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6,8</span></a> the more disability at the beginning, the worse treatment response and the lower the probability of achieving remission. In our research, we found a correlation between a lower HAQ score and remission, correlation also observed in a French cohort of 191 AR patients<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> and in the BARFOT cohort.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> Although, neither in our or in previous studies, HAQ score has been identified as an independent predictor factor.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Acute Phase Reactants (APR)</span><p id="par0095" class="elsevierStylePara elsevierViewall">In our study, we found an association between ESR<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>30 and sustained remission, that has been previously observed in other studies,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> but this association was not seen after the multivariate analysis. Regarding CRP or anemia, although patients in clinical remission had lower levels of CRP and less anemia, this data was not related to remission. Vázquez et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> found a relation between low levels of hemoglobin and a lower probability of remission and in a French cohort,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> they found a higher probability of remission in patients with levels of CRP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>14.5<span class="elsevierStyleHsp" style=""></span>mg/l. In two adalimumab studies,<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6,12</span></a> they found CRP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mg/l as an independent factor of remission.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Serological Markers</span><p id="par0100" class="elsevierStylePara elsevierViewall">Serum levels of RF and ACPA have been identified as poor prognostic factors in RA, although, being ACPA or RF negative, is not clearly related to a better outcome. In our study we did not find a relation between RF or ACPA and remission. In previous researches, RF negativity has been associated with remission<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3,9–11</span></a> but not as an independent factor. Regarding ACPA, only one study has found association between its negativity and remission.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Comorbidities</span><p id="par0105" class="elsevierStylePara elsevierViewall">Comorbidities in RA patients were not associated with remission in our study. The comorbidities profile on patients with RA is similar to the profile seen in other studies, where hypertension is the most prevalent comorbidity and the percentages of diabetes, depression and infarct are similar. We did not find a relation between Charlson comorbidity index and remission, association that has not been evaluated previously.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Toxic Habits</span><p id="par0110" class="elsevierStylePara elsevierViewall">Although smoking is a poor prognostic factor in RA,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> in this study there was no relation found between tobacco and remission.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Treatments</span><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding treatments, an adequate adherence to treatments was related to the probability of achieving remission at some point during the follow up. We also found a relation between the use of DMARDs in monotherapy and sustained remission. That is a fact that could be explained because, normally, patients with better response to treatments, have a less aggressive disease so they require less intensification of therapies. Therefore, a patient with a good response to methotrexate in monotherapy, with a good symptom follow up and low disease activity, probably will not need to add another DMARD. So, this patient profile will achieve remission in monotherapy.</p><p id="par0120" class="elsevierStylePara elsevierViewall">2nd suggestion → The use of biologic DMARD in monotherapy was associated with persistent remission in the last year. But regarding this concept, we have to say that it was a small number of patients (15), and half of them were treated with tocilizumab, biologic agent that, as it is known, reduces in a significant way ESR levels and therefore leads to lower DAS28 scores.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> In general terms, biologic therapy was not associated with remission, probably due to a bias in prescription: patients receiving biologic DMARD are those patients that have not responded to conventional therapy with DMARDs and therefore have a more severe RA.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Another variable associated with remission in our patients was the good EULAR response to the first treatment. The good clinical response after the initial treatment has been identified as a remission predictor factor in some studies.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">9,12,15</span></a> In a study of the TARACT cohort with 366 patients, the good EULAR response during the first year (OR 3.1) was found as an independent predictor factor of sustained remission in the last two visits.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> In the RAPID1 study with Certolizumab pegol, with 703 patients with a disease duration of 6 years and a medium value of DAS28 of 7 (high activity), they observed that patients with a good response to treatment at weeks 4, 6 and 8, had a higher probability of achieving reduced disease activity during the first year. Achieving reduced disease activity or a decrease in the DAS28 score with the first treatment was associated with remission at some point during the follow up and with sustained remission in the last year.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> Not only the good EULAR response to the first treatment, but also achieving remission during the first year of treatment, was associated with sustained remission in our patients. This association has been observed in the ESPOIR study.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> In the study of the cohort CORRONA<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> they observed that patients that were in remission during the first year, have a higher probability to continue in remission.</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusion</span><p id="par0130" class="elsevierStylePara elsevierViewall">We concluded that the initial presentation and situation of the patient and the delay in the first visit to the Rheumatologist will determine the future of the disease. The RA activity at the basal visit will be the key for the achievement of the therapeutic goals. The modifiable factors consist in improving the derivation of patients from the primary care to the specialist to make an early diagnosis and initiate an intensive treatment as soon as possible.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The present research presents various strengths. The relevance of this research is that we have studied real live patients of the Rheumatology Department. Its importance lies with its observation of real clinical practise, with an important number of patients with a medium follow up of almost 10 years. All the rheumatologists in the department have a systematic way of work, either in the first visit or subsequent visits.</p><p id="par0140" class="elsevierStylePara elsevierViewall">On the other hand, our study presents limitations. It is a retrospective study with patients with a follow up of almost 10 years, so that, not all data was available for revision and some data was collected after the fact, such as calculation of activity index scores.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Clinical remission is the goal of the treatment of RA patients. A non modifiable factor of poor prognosis is female gender; but an early diagnosis and a good EULAR response to the first treatment will improve the achievement of therapeutic goals. Moreover, a lower disease activity using DAS28 in the first visit is a predictor factor of remission in RA patients.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Ethics Approval</span><p id="par0150" class="elsevierStylePara elsevierViewall">Ethical Committee of the University Hospital of Gran Canaria Dr Negrín.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Funding</span><p id="par0155" class="elsevierStylePara elsevierViewall">This study has not been supported by any public nor private entity.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflict of Interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1389122" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1274409" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1389123" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0030" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1274408" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Measures and Data Collection" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0030" "titulo" => "Discussion" "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Cohort Characteristics" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Prognostic Factors of Sustained Remission" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Early Diagnosis" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "RA Activity in the First Visit" ] 4 => array:2 [ "identificador" => "sec0055" "titulo" => "Functional Capacity" ] 5 => array:2 [ "identificador" => "sec0060" "titulo" => "Acute Phase Reactants (APR)" ] 6 => array:2 [ "identificador" => "sec0065" "titulo" => "Serological Markers" ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "Comorbidities" ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Toxic Habits" ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Treatments" ] ] ] 8 => array:2 [ "identificador" => "sec0085" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0090" "titulo" => "Ethics Approval" ] 10 => array:2 [ "identificador" => "sec0095" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0100" "titulo" => "Conflict of Interest" ] 12 => array:2 [ "identificador" => "xack483085" "titulo" => "Acknowledgements" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-04-26" "fechaAceptado" => "2018-10-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1274409" "palabras" => array:5 [ 0 => "Rheumatoid arthritis" 1 => "DAS28" 2 => "Activity disease" 3 => "Remission" 4 => "Prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1274408" "palabras" => array:5 [ 0 => "Artritis reumatoide" 1 => "DAS28" 2 => "Actividad de la enfermedad" 3 => "Remisión" 4 => "Pronóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rheumatoid arthritis (RA) is the most frequent chronic polyarthritis. The current goal of RA treatment is to achieve clinical remission.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The goal of this study was to determine the prevalence of remission in a cohort of patients from clinical practice, and to identify potentially modifiable factors associated with remission.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A retrospective study was performed on a cohort of RA patients seen at the first consultation at the HUGC Rheumatology Service Dr. Negrín (HUGCDN) between first of January 2000 and thirtieth of April 2014. Sustained remission was defined as DAS28 less than 2.6 in the last two available visits in the medical history.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 463 patients were consecutively included, most (75%) women, with a mean age at the onset of RA of 50 years and a mean duration of the disease at follow-up of 8 years. 46% of the patients achieved sustained remission. Multiple logistic regression analyses found male sex (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.031, OR 1.7, 95% CI 1.05–2.82), diagnosis in the first year of symptoms (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.023, OR 1.7, 95% CI 1.07–2.69) and the initial DAS28 (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.035) to be independent predictors for sustained remission.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The 46% of the patients with RA followed in the HUGC Dr. Negrín are in persistent remission, being the early diagnosis a modifiable factor predictor of remission. Thus, an objective of the Rheumatology Service should be to improve the diagnostic delay of RA in the health area.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Introducción La artritis reumatoide (AR) es la poliartritis crónica más frecuente. El objetivo actual del tratamiento de la AR es lograr la remisión clínica.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue determinar la prevalencia de la remisión en una cohorte de pacientes de la práctica clínica, e identificar factores potencialmente modificables asociados con la remisión.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio retrospectivo en una cohorte de pacientes con AR observada en la primera consulta del Servicio de Reumatología del Hospital Universitario de Gran Canaria Dr. Negrín (HUGCDN) entre el primero de enero de 2000 y el 30 de abril de 2014. La remisión mantenida se definió como DAS28 menor de 2,6 en las 2 últimas visitas recogidas en la historia clínica.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron consecutivamente 463 pacientes, la mayoría (75%) mujeres, con una edad media al inicio de la AR de 50 años y la duración media de la enfermedad en el seguimiento de 8 años. El 46% de los pacientes alcanzaron la remisión sostenida. Los análisis de regresión logística múltiple encontraron que el sexo masculino (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,031; OR: 1,7; IC del 95%: 1,05-2,82), el diagnóstico en el primer año de síntomas (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,023; OR: 1,7; IC del 95%: 1,07-2,69) y el DAS28 inicial (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,035) fueron factores predictores independientes de remisión sostenida.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El 46% de los pacientes con AR seguidos en el HUGCDN están en remisión persistente, siendo el diagnóstico precoz un factor predictor modificable de la remisión. Así, un objetivo del servicio de reumatología debe ser mejorar el retraso diagnóstico de la AR en el área de salud.</p></span>" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0030" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">RF: rheumatoid factor; ACPA: anti-cyclic citrullinated peptide antibody; DAS28: disease activity score in 28 joints; DMARDs: synthetic disease modifying antirheumatic drugs, DMARDb: biologic synthetic disease modifying antirheumatic drugs.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">N</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">463 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean age at diagnosis (SD<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.7 (14.8) years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean disease duration (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.4 (6.4) years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean follow-up duration (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.8 (3.2) years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis during the first year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.4% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RF (+) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ACPA (+) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.4% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bone erosions in X-rays \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate/high activity first visit (DAS28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial DAS28 (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.7 (1.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DMARDs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DMARDb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Appropriate adherence to established therapeutical guidelines \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good EULAR response to the first treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Remission during the first year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Remission in a point during the follow up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sustained remission in the last two visits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2384755.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">SD: standard deviation.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Baseline Cohort Characteristics.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">VAS: visual analog scale; HAQ: health assessment questionnaire disability index; DAS28: disease activity score in 28 joints; ESR: erythrocyte sedimentation rate; DMARDb: biologic synthetic disease modifying antirheumatic drugs; DMARDs: synthetic disease modifying antirheumatic drugs.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Associated factors with remission \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Early diagnosis during the first year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.013 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial VAS pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial HAQ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.011 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial DAS28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.021 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial ESR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.045 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EULAR good response to the first treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Remission during the first year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.042 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DMARDb in monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DMARDs in monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.049 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2384753.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Univariate Analysis.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The values expressed in bold are the values with statistical significance.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">B</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sig. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.543 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">0.031</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.721 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.051–2.820 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial DAS28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.140 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">0.035</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.150 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.010–1.311 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Remission during the first year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.689 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.053 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.502 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.250–1.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good EULAR response to the first treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.084 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.639 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.088 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.765–1.547 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Early diagnosis during the first year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.532 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">0.023</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.702 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.075–2.694 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2384754.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Multivariate Analysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0090" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. EPISER Study Group" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Carmona" 1 => "J. Ballina" 2 => "R. Gabriel" 3 => "A. Laffon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.60.11.1040" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2001 Nov" "volumen" => "60" "paginaInicial" => "1040" "paginaFinal" => "1045" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11602475" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0095" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Remission and rheumatoid arthritis data on patients receiving usual care in twenty-four countries" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Sokka" 1 => "M.L. Hetland" 2 => "H. Mäkinen" 3 => "H. Kautiainen" 4 => "K. Hørslev-Petersen" 5 => "R.K. Luukkainen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.23794" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheumat" "fecha" => "2008" "volumen" => "58" "paginaInicial" => "2642" "paginaFinal" => "2651" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18759292" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0100" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sex: a major predictor of remission in early rheumatoid arthritis?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Forslind" 1 => "I. Hafström" 2 => "M. Ahlmen" 3 => "Svensson B:" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2006.056937" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2007" "volumen" => "66" "paginaInicial" => "46" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17158139" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0105" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of the long-term outcome for patients with rheumatoid arthritis with persistent moderate disease activity or disease remission during the first year after diagnosis: data from the ESPOIR cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Combe" 1 => "I. Logeart" 2 => "M.C. Belkacemi" 3 => "S. Dadoun" 4 => "T. Schaeverbeke" 5 => "J.P. Daurès" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2014" "volumen" => "0" "paginaInicial" => "1" "paginaFinal" => "6" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0110" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence of clinical remission in RA patients treated with anti-TNF: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.M. De Punder" 1 => "J. Fransen" 2 => "W. Kievit" 3 => "P.M. Houtman" 4 => "H. Visser" 5 => "M.A. van de Laar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2012" "volumen" => "51" "paginaInicial" => "1610" "paginaFinal" => "1617" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0115" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical remission and/or minimal disease activity in patients receiving adalimumab treatment in a multinational, open-label, twelve-week study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.R. Burmester" 1 => "G. Ferraccioli" 2 => "R.M. Flipo" 3 => "I. Monteagudo-Sáez" 4 => "K. Unnebrink" 5 => "S. Kary" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.23247" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2008" "volumen" => "59" "paginaInicial" => "32" "paginaFinal" => "41" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18163417" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0120" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Significance of sex in achieving sustained remission in the consortium of rheumatology researchers of North America cohort of rheumatoid arthritis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Jawaheer" 1 => "S. Messing" 2 => "G. Reed" 3 => "V.K. Ranganath" 4 => "J.M. Kremer" 5 => "J.S. Louie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2012" "volumen" => "64" "paginaInicial" => "1811" "paginaFinal" => "1818" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0125" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Remission and rheumatoid arthritis: data on patients receiving usual care in twenty-four countries" ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.23794" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2008" "volumen" => "58" "paginaInicial" => "2642" "paginaFinal" => "2651" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18759292" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0130" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The good EULAR response at the first year is strongly predictive of clinical remission in rheumatoid arthritis: results from the TARAC cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Darawankul" 1 => "S. Chaiamnuay" 2 => "R. Pakchotanon" 3 => "P. Asavatanabodee" 4 => "P. Narongroeknawin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-014-2749-1" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2015" "volumen" => "34" "paginaInicial" => "43" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25060487" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0135" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic factors for remission in early rheumatoid arthritis: a multiparameter prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Gossec" 1 => "M. Dougados" 2 => "P. Goupille" 3 => "A. Cantagrel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2003.010611" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2004" "volumen" => "63" "paginaInicial" => "675" "paginaFinal" => "680" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15140774" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0140" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Good clinical response, remission, and predictors of remission in rheumatoid arthritis patients treated with tumor necrosis factor-alpha blockers: the GISEA study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Mancarella" 1 => "F. Bobbio-Pallavicini" 2 => "F. Ceccarelli" 3 => "P.C. Falappone" 4 => "A. Ferrante" 5 => "D. Malesci" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Rheumatol" "fecha" => "2007" "volumen" => "348" "paginaInicial" => "1670" "paginaFinal" => "1673" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0145" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic markers of clinical remission in early rheumatoid arthritis after two years of DMARDs in a clinical setting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Vázquez" 1 => "E. Graell" 2 => "J. Gratacós" 3 => "J.D. Cañete" 4 => "O. Viñas" 5 => "M.G. Ercilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2007" "volumen" => "25" "paginaInicial" => "231" "paginaFinal" => "238" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17543147" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0150" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized con-trolled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Matcham" 1 => "S. Norton" 2 => "D.L. Scott" 3 => "S. Steer" 4 => "M. Hotopf" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2016" "volumen" => "55" "paginaInicial" => "268" "paginaFinal" => "278" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0155" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alcohol consumption is associated with lower self-reported disease activity and better health-related quality of life in female rheumatoid arthritis patients in Sweden: data from BARFOT, a multicenter study on early RA" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Bergman" 1 => "S. Symeonidou" 2 => "M.L. Andersson" 3 => "M.K. Söderlin" 4 => "BARFOT. study group" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2474-14-218" "Revista" => array:5 [ "tituloSerie" => "BMC Musculoskelet Disord" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "218" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23879655" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0160" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologicals: results from a 24-week multicentre randomised placebo-controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Emery" 1 => "E. Keystone" 2 => "H.P. Tony" 3 => "A. Cantagrel" 4 => "R. van Vollenhoven" 5 => "A. Sanchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2008" "volumen" => "68" "paginaInicial" => "1516" "paginaFinal" => "1523" "itemHostRev" => array:3 [ "pii" => "S0091674901358529" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0165" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A good response to early DMARD treatment of patients with rheumatoid arthritis in the first year predicts remission during follow up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Verstappen" 1 => "G.A. van Albada-Kuipers" 2 => "J.W. Bijlsma" 3 => "A.A. Blaauw" 4 => "Y. Schenk" 5 => "H.C. Haanen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2003.014928" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2005" "volumen" => "64" "paginaInicial" => "38" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15130899" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0170" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors and persistence of new-onset clinical remission in rheumatoid arthritis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Navarro-Millán" 1 => "L. Chen" 2 => "J.D. Greenberg" 3 => "D.A. Pappas" 4 => "J.R. Curtis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2013.02.002" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2013" "volumen" => "43" "paginaInicial" => "137" "paginaFinal" => "143" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23742957" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack483085" "titulo" => "Acknowledgements" "texto" => "<p id="par0165" class="elsevierStylePara elsevierViewall">The authors would like to thank all members of the Rheumatology Department of Hospital Universitario Gran Canaria Dr Negrín.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/1699258X/00000016000005P2/v1_202009230737/S1699258X18302316/v1_202009230737/en/main.assets" "Apartado" => array:4 [ "identificador" => "17499" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/1699258X/00000016000005P2/v1_202009230737/S1699258X18302316/v1_202009230737/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X18302316?idApp=UINPBA00004M" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 4 | 6 | 10 |
| 2024 Octubre | 41 | 44 | 85 |
| 2024 Septiembre | 53 | 33 | 86 |
| 2024 Agosto | 60 | 56 | 116 |
| 2024 Julio | 55 | 48 | 103 |
| 2024 Junio | 69 | 39 | 108 |
| 2024 Mayo | 55 | 38 | 93 |
| 2024 Abril | 63 | 37 | 100 |
| 2024 Marzo | 42 | 40 | 82 |
| 2024 Febrero | 30 | 43 | 73 |
| 2024 Enero | 51 | 22 | 73 |
| 2023 Diciembre | 34 | 28 | 62 |
| 2023 Noviembre | 52 | 38 | 90 |
| 2023 Octubre | 31 | 24 | 55 |
| 2023 Septiembre | 149 | 41 | 190 |
| 2023 Agosto | 28 | 16 | 44 |
| 2023 Julio | 40 | 27 | 67 |
| 2023 Junio | 37 | 23 | 60 |
| 2023 Mayo | 46 | 31 | 77 |
| 2023 Abril | 28 | 8 | 36 |
| 2023 Marzo | 56 | 31 | 87 |
| 2023 Febrero | 57 | 17 | 74 |
| 2023 Enero | 25 | 13 | 38 |
| 2022 Diciembre | 67 | 40 | 107 |
| 2022 Noviembre | 48 | 31 | 79 |
| 2022 Octubre | 66 | 34 | 100 |
| 2022 Septiembre | 40 | 34 | 74 |
| 2022 Agosto | 33 | 45 | 78 |
| 2022 Julio | 30 | 44 | 74 |
| 2022 Junio | 36 | 24 | 60 |
| 2022 Mayo | 34 | 38 | 72 |
| 2022 Abril | 54 | 43 | 97 |
| 2022 Marzo | 32 | 52 | 84 |
| 2022 Febrero | 50 | 41 | 91 |
| 2022 Enero | 62 | 29 | 91 |
| 2021 Diciembre | 39 | 37 | 76 |
| 2021 Noviembre | 53 | 56 | 109 |
| 2021 Octubre | 52 | 48 | 100 |
| 2021 Septiembre | 33 | 50 | 83 |
| 2021 Agosto | 25 | 33 | 58 |
| 2021 Julio | 24 | 43 | 67 |
| 2021 Junio | 33 | 55 | 88 |
| 2021 Mayo | 42 | 40 | 82 |
| 2021 Abril | 92 | 72 | 164 |
| 2021 Marzo | 63 | 45 | 108 |
| 2020 Noviembre | 3 | 4 | 7 |
| 2020 Octubre | 4 | 8 | 12 |
| 2020 Septiembre | 1 | 2 | 3 |
| 2020 Junio | 1 | 2 | 3 |
| 2019 Septiembre | 2 | 0 | 2 |
| 2019 Mayo | 0 | 2 | 2 |
| 2018 Diciembre | 1 | 0 | 1 |
Mostrar todo
