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Title: The REMIRA (REMission in RA) study : defining Low Disease Activity (LDA) states using clinical, imaging and biological measures in Rheumatoid Arthritis
Author: Ma, Margaret Har Yin
ISNI:       0000 0004 5368 0919
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2014
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Rheumatoid Arthritis (RA) is a heterogeneous disease with variable outcomes. Its contemporary treatment has made remission a reality with an increasing proportion of patients achieving this target. The goal of this thesis was to improve knowledge of RA remission and its clinical implications. It had three aims. Firstly to define remission and sustained remission using an extended range of clinical, laboratory and radiological biomarkers. Secondly to identify clinical and laboratory predictors of remission. Thirdly, to assess the impact of remission on health-related quality of life. Systematically reviewing published early RA studies showed 17% achieved remission using the most stringent criteria and 33% using the least stringent criteria. Intensive treatment increased the frequency and structural benefits of remission. Modelling studies in early RA patients from an early RA trial and large observational cohort showed remission was predicted by age, gender, and tender joint count. Studies in a new, unique cohort of 104 RA patients with stable low disease activity followed for 12 months (REMIRA) showed remission was frequent with the least stringent criteria and rare with the most stringent ones. Only a minority of patients achieved sustained remissions. Ethnicity and conventional disease activity assessments predicted sustained remissions. Sustained remissions were also predicted by the multi-biomarker disease activity score and four of its components (highly sensitive C-reactive protein, serum amyloid-A protein, interleukin-6 and leptin). Finally, achieving sustained remission maximised quality of life outcomes compared to low disease activity states throughout the study period. This thesis has made novel contributions towards the understanding of RA remission which has important impact in the clinical setting. The use of clinical and laboratory biomarkers can predict sustained remission and therefore guide treatment decisions. With the growing emphasis on personalised medicine, this thesis brings us one step closer to achieving individualised care in RA.
Supervisor: Cope, Andrew Paul ; Scott, David Lloyd Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available