PREDICTORS OF RHEUMATOID ARTHRITIS FLARE AFTER GLUCOCORTICOIDS WITHDRAWAL WHILE RECEIVING CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS

Summary: Predictors of rheumatoid arthritis (RA) flare after glucocorticoid (GC) withdrawal while receiving conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). The aim of this study is to investigate predictors of RA flare following GC withdrawal despite the continuation of csDMARDs in the Ukrainian cohort of patients with different disease durations. Materials and methods: One hundred twenty-six patients with early (56.3%) and advanced (43.7%) RA who newly started GC as bridging therapy with concomitant csDMARDs were included in the study. Most were female – 107 (84.9%), seropositive (RF: 60.3%; ACCP: 60.9%), with a mean age of 51.0±11.4 and disease duration of 42.1±57.6 months. Results: During the 3-year study, 89 patients managed to quit GC without further disease aggravation over a period of 3 to 30 months. Exacerbation of RA was observed in 29.4% of patients. Patients with RA flare had 1.7 times longer duration of GC exposure (ꭓ 2 =4.17, p < 0.05), a shorter duration of remission (ꭓ 2 =10.9, р < 0,01), higher disease activity after 12 months of therapy (р < 0,01), a cumulative GC dose (p < 0.001) and a higher proportion of dissatisfied control of RA (ꭓ2=45,5, р < 0,001) compared to the alternative group. In multivariate and ROC analysis, a higher cumulative GC dose (OR 17.4[2.62-116.4]; regression criterion >1.37), RA activity after 12 months (OR 4.06 [1.36-12.0]; regression criterion > 4.37) and dissatisfied control of RA activity were independently associated with the risk of RA flare after GC discontinuation. Conclusions: The flare following GC withdrawal is observed in one-third of patients with RA undergoing csDMARD therapy. Indicators of dynamic monitoring, rather than baseline data, affect the risk of RA exacerbation. Independent predictors of increased RA activity after GC withdrawal are a higher cumulative GC dose, dissatisfied control of RA activity and a higher DAS28 (ESR) after 12 months of treatment.