Characteristics and prevalence of clinical remission of rheumatoid arthritis in a nationwide study from Indonesia

Author:

Suryana Bagus Putu Putra1ORCID,Hidayat Rudy2ORCID,Sarmidi Sumariyono2,Wibowo Suryo Anggoro Kusumo2,Hamijoyo Laniyati3ORCID,Rahmadi Andri Reza3,Marpaung Blondina4,Ginting Andi Raga4,Kambayana Gede5,Kurniari Pande Ketut5,Sylvawani Mahriani6,Najirman 7,Suarjana Nyoman8,Achadiono Deddy Nur Wachid9,Rahmawati Lita Diah10,Awalia 10,Suntoko Bantar11,Warlisti Ika Vemilia11,Nurudhin Arief12,Prabowo Nurhasan Agung12,Partan Radiyati Umi13,Reagan Muhammad13,Adnan Endy14,Ongkowijaya Jeffrey Arthur15,Akil Natsir16,Pratama Mirza Zaka1ORCID

Affiliation:

1. Rheumatology Division Department of Internal Medicine, Faculty of Medicine Universitas Brawijaya Saiful Anwar General Hospital Malang Indonesia

2. Rheumatology Division Department of Internal Medicine, Faculty of Medicine Universitas Indonesia Cipto Mangunkusumo National Central General Hospital Jakarta Indonesia

3. Rheumatology Division Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran Hasan Sadikin General Hospital Bandung Indonesia

4. Rheumatology Division Department of Internal Medicine Faculty of Medicine Universitas Sumatera Utara Medan Indonesia

5. Rheumatology Division Department of Internal Medicine, Faculty of Medicine Universitas Udayana Sanglah General Hospital Denpasar Denpasar Bali Indonesia

6. Rheumatology Division Department of Internal Medicine Faculty of Medicine Universitas Syah Kuala Banda Aceh Indonesia

7. Rheumatology Division Department of Internal Medicine Faculty of Medicine Universitas Andalas Padang Indonesia

8. Rheumatology Division Department of Internal Medicine Faculty of Medicine Universitas Lambung Mangkurat Banjarmasin Indonesia

9. Rheumatology Division Department of Internal Medicine Faculty of Medicine Universitas Gadjah Mada Yogyakarta Indonesia

10. Rheumatology Division Department of Internal Medicine Faculty of Medicine Universitas Airlangga, Dr Soetomo General Hospital Surabaya Indonesia

11. Rheumatology Division Department of Internal Medicine Faculty of Medicine Universitas Diponegoro, Dr Kariadi General Hospital Semarang Indonesia

12. Rheumatology Division Department of Internal Medicine Faculty of Medicine Universitas Sebelas Maret, Dr Moewardi General Hospital Solo Indonesia

13. Rheumatology Division Department of Internal Medicine Faculty of Medicine Universitas Sriwijaya, Mohammad Hoesin General Hospital Palembang Indonesia

14. Rheumatology Division Department of Internal Medicine Faculty of Medicine Universitas Hasanudin Makassar Indonesia

15. Rheumatology Division Department of Internal Medicine Faculty of Medicine Universitas Sam Ratulangi Manado Indonesia

16. Department of Internal Medicine Kanujoso Djatiwibowo General Hospital Balikpapan Indonesia

Abstract

AbstractAimTo investigate the clinical characteristics, DMARD treatment pattern, remission rate, and factors associated with disease remission of rheumatoid arthritis (RA) patients in Indonesia.MethodA multicenter survey was conducted in 2019–2020 involving 16 hospitals in Indonesia. Inclusion criteria were RA patients who fulfilled the 2010 ACR/EULAR classification criteria, were aged ≥18 years, and have been treated with 1 DMARD or more for at least 6 months, with exclusion criteria being the co‐existence of other autoimmune diseases or pain syndromes. Disease activities and remission rate were defined using DAS28‐ESR.ResultsA total of 870 patients were completed for analysis. Remission was achieved in 24.5% of patients, while low disease activity in 18.5%, moderate disease activity in 44.6%, and high disease activity in 12.4%. The distribution of conventional DMARDs from subjects was methotrexate 69.9%, leflunomide 15.9%, sulfasalazine 12.0%, chloroquine/hydroxychloroquine 8.9%, and cyclosporine 4.8%. Patients treated with biologic DMARDs were only 0.3%. The mean methotrexate dose was 11.2 ± 4.0 mg/week, and the mean methotrexate duration was 45.1 ± 36.6 months. The majority of patients received glucocorticoids (65.5%). 71.1% received DMARD monotherapy, while 28.9% had combined DMARDs. According to the multivariate analysis, delayed time to diagnosis and treatment (>6 months), DMARD monotherapy, and glucocorticoid use were negatively associated with disease remission.ConclusionThe remission rate of Indonesian RA patients is 24.5%, and low disease activity is 18.5%. Methotrexate and leflunomide are the most frequent conventional DMARDs used. Delayed diagnosis, delayed treatment, and DMARD monotherapy contributed to the current low remission rate in Indonesia.

Publisher

Wiley

Subject

Rheumatology

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