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

Research output: Contribution to journalArticlepeer-review

Sook Yan Lee, Fowzia Ibrahim, Brian D.M. Tom, Elena Nikiphorou, Frances M.K. Williams, Heidi Lempp, David L. Scott

Original languageEnglish
Article number278
Number of pages1
JournalArthritis Research and Therapy
Issue number1
Early online date4 Nov 2021
E-pub ahead of print4 Nov 2021
PublishedDec 2021

Bibliographical note

Funding Information: This study was funded by the National Institute for Health Research (NIHR) [Programme Grants for Applied Research (Grant Reference Number RP-PG-0610-10066)]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Funding Information: BT is supported by the UK Medical Research Council (Unit Programme number MC_UP_1302/3 & MRC_MC_UU_00002/2) and by the NIHR Cambridge Biomedical Research Centre. Publisher Copyright: © 2021, The Author(s).

King's Authors


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

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