Faktor-Faktor Klinis Dan Laboratoris Yang Berhubungan Dengan Remisi Pasien Artritis Reumatoid Dengan Terapi Metotreksat
Daftar Isi:
- Background: Rheumatoid arthritis (RA) is autoimmune disease which etiology remain unclear, with symetris erosive synovitis and in some case followed with extraarticular involvement. Methotrexate is most common DMARD (Disease Modifying Rheumatoid Drug) used in RA, but response to methotrexate is vary among population. A study shows RA remission level using methotrexate is 33-65%. There is inconsistence data in clinical and laboratory factors to determine or predict remission in RA treated with convensional DMARD. Objective: To assest clinical and laboratory factors which associate with remission in RA treated with methotrexate. Methods: We included data from RA patients in Saiful Anwar Hospital-Malang who fulfilled (American College of Rheumatology-European League Against Rheumatism) ACR-EULAR 2010 criteria in an exploratory retrospective observational study with cross sectional approach. Patients initial assesment and follow up data were collected. We examine initial clinical and laboratory data including gender, age at onset, duration of disease, Body Mass Index (BMI), Tender Joint Count (TJC), Swollen Joint Count (SJC), pain Visual Analog Scale (VAS), initial Disease Activity Score (DAS)-28, Eryhtrocyte Sedimentation Rate (ESR), anti Cyclic Citrullinated Protein (CCP), and Rheumatoid Factor (RF). Variables were analyzed using Chi-square or Fisher as appropriate and continue with multiple logistic regression and developed a predictive equation to determine remission probablity. Result: The study included 88 patients after screening for inclusion and exclusion criteria. Study population consist of 85.2% women (n = 75) and 14.8% men (n = 13), mean age was 54.78 ± 11.34. Initial methotrexate dose was 8.8 ± 2,1 mg/week. Remission rate in RA patient treated with methotrexate in our hospital is 26,1%. Bivariate analysis shows three variables giving significance result associate with remission outcome. There are age at onset (p = 0.037, Odds Ratio (OR) = 3.375), pain VAS (p = 0.030, OR = 3.108), and ESR (p = 0.038, OR = 2.807). Multivariate logistic regression analysis shows only age at onset giving a significance result (p = 0.049, OR = 3.473). Probability remission equation was y = -6,197 + 1,245 (age at onset) + 0,999 (VAS) + 1,042 (ESR). Remission probablity = 1/(12+ 2,7-y) Conclusion: Age at onset, pain VAS, and ESR are factors associate with remission in RA using methotrexate.