Mental Health Could Predict RA Flare

Disease activity and mental health status are both associated with the risk for flare in patients with rheumatoid arthritis (RA) who taper their anti-tumor necrosis factor (TNF) therapy, according to new research.

This finding emerged from a post-hoc analysis of the Optimizing TNF Tapering in RA trial, which included 97 patients with RA with sustained low disease activity. Patients were randomly assigned to taper their anti-TNF dose by either 33% or 66%.
_________________________________________________________________________________

RELATED CONTENT
40% of Arthritis Patients Still Do Not Receive Exercise Counseling
Treating Early Arthritis Reduces RA Risk
_________________________________________________________________________________

Patient data were obtained at baseline using the Health Assessment Questionnaire, EuroQol 5-dimension scale, Functional Assessment of Chronic Illness Therapy fatigue scale, and the 36-Item Short Form Survey.

The primary outcome was flare—defined as an increase in 28-joint count Disease Activity Score (DAS28) of at least 0.6 and at least 1 swollen joint. Patient-reported outcomes that could predict flare were identified via discrete-time survival models.

A total of 41 patients had a flare. Results of the study indicated that higher DAS28 score was associated with flare (adjusted hazard ratio [HR] 1.96), as were disability, fatigue, and mental health in unadjusted models.

However, findings from multivariate analyses showed that mental health remained a statistically significant predictor of flare (adjusted HR per 10 units: 0.74), but that disability and fatigue did not.

“Baseline DAS28 and mental health status are independently associated with flare in patients who taper their anti-TNF therapy,” the researchers wrote. “Fatigue and function also associate with flare but the effect disappears when adjusting for confounders.”

“Given these findings, mental health and functional status should be considered in anti-TNF tapering decisions in order to optimize the likelihood of success,” they concluded.

—Christina Vogt

Reference:

Bechman K, Sin FE, Ibrahim F, et al. Mental health, fatigue and function are associated with increased risk of disease flare following TNF inhibitor tapering in patients with rheumatoid arthritis: an exploratory analysis of data from the Optimizing TNF Tapering in RA (OPTTIRA) trial [Published online May 17, 2018]. RMD Open. doi:10.1136/rmdopen-2018-000676