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. 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. 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. 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. ISRCTN 70160382 ; date registered 16 January 2014

中文翻译：

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类风湿关节炎缓解、疼痛和疲劳的基线预测因子：TITRATE 试验

临床试验表明，诱导缓解的强化治疗对高度活跃的类风湿性关节炎 (RA) 患者有效。TITRATE 试验表明，强化治疗的益处也延伸到中度活动性 RA。然而，许多患者未能达到缓解或疼痛和疲劳的改善。我们调查了基线预测因子是否可以识别治疗无反应者。肥胖、抑郁、焦虑和疾病感知对 RA 结果的影响，包括疾病活动、缓解、疼痛和疲劳，是使用预先计划的对 TITRATE 试验数据的二次分析确定的。体重指数与疾病活动水平和缓解相关：肥胖患者的总体疾病活动较高，而获得缓解的肥胖患者较少。强化管理与这些患者的缓解增加无关。肥胖还与整体疼痛和疲劳增加有关。焦虑、抑郁和健康观念对疾病活动没有明显影响，但与高水平的疼痛和疲劳有关。焦虑与高疼痛评分之间存在很强的关联；以及在抑郁和高疲劳评分之间；健康感知与两者密切相关。在横断面分析中，没有一个预测因素对减轻疼痛和疲劳产生重要影响。肥胖患者的疾病活动度较高，他们在 12 个月内的缓解较少。焦虑、抑郁和健康认知与较高的疼痛和疲劳评分相关。强化管理策略需要考虑这些基线特征，因为它们对临床和心理结果有显着影响。ISRCTN 70160382；注册日期 2014 年 1 月 16 日