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ORIGINAL ARTICLE
Year : 2009  |  Volume : 4  |  Issue : 2  |  Page : 51-55

Effect of baseline rheumatoid factor (RF) levels on DAS28-response to standard DMARD-combination treatment in patients with rheumatoid arthritis (RA)


1 A&R Clinic Vasant Kunj, and Joint Disease Clinic, Department of Rheumatology, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India,
2 UND Department of Mathematics, Grand Forks, North Dakota
3 Internal Medicine Resident, Michigan State University, East Lansing, Michigan
4 Clinical Associate Professor in Medicine, UND School of Medicine & Health Sciences, North Dakota, USA

Correspondence Address:
Anand N Malaviya
A&R Clinic Vasant Kunj, and Joint Disease Clinic, Department of Rheumatology, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India,

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Source of Support: None, Conflict of Interest: None


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Objective: Rheumatoid factor (RF) positivity has been associated with an unfavourable outcome in rheumatoid arthritis (RA). Our study aimed to find a baseline RF cut-off level that would determine the response to standard disease modifying anti-rheumatic drug (DMARD) combination treatment. Patients and methods: We studied 233 seropositive (RF levels ≥ 20 IU/mL at presentation) RA patients over a period of up to 5 years. Disease activity was assessed at each patient-encounter using disease activity score on 28 joints (DAS28). Treatment consisted of weekly methotrexate, daily hydroxychloroquine and low dose oral methlypred- nisolone as an adjunct. Sulfasalazine or leflunomide were added to the ongoing regimen if satisfactory response was not achieved by 3 months of treatment. Individual response of patients to treatment was graded using the fol- lowing DAS28 cut-off values: < 3 as low disease activity (satisfactory response), ≥ 3 as moderate and ≥ 5.1 as high (unsatisfactory response). Results: By analyzing all possible 2 × 2 contingency tables based on the different values of RF in the data set, using Fisher's exact test of association between RF levels and DAS28 values, a cut-off level for RF of 70 IU/mL gave the optimal discrimination between 'low' versus 'moderate or high' disease activity in the follow-up. Conclusion: A baseline RF cut-off value of 70 IU/mL appears to predict a 'satisfactory' versus 'unsatisfactory' response to standard DMARD-combination therapy in RA over time.


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