The aim of this thesis was to identify and compare objective measures and predictors of remission. This was done in a cohort of patients with established RA, early RA and very early undifferentiated arthritis with poor prognostic markers. The objective markers used to define the remission state included clinical (remission scores, clinical examination, inflammatory markers and antibody status), imaging (ultrasound [US] assessment for power Doppler [PD] activity) and immunology (assessment of T cell subtypes) assessments. In patients with established RA treated with combination TNF blocker therapy and disease modifying anti-rheumatic therapy [DMARD] therapy, the remission state is associated with longer disease duration, shorter time in remission, worse health assessment questionnaire [HAQ] scores and comparable PD activity when compared to patients in remission treated with DMARDs. When TNF blocker treated patients with established RA were compared to those with early RA, there were no differences in PD activity, but patients with early RA were significantly more likely to sustain remission after cessation of TNF blocker therapy. In patients with early disease, predictors of successful cessation were short duration of symptoms and a pattern of T cell subtypes that is associated with normalisation of the immune system and recapitulation of thymic activity. It was then proposed to use TNF blocker therapy to induce longstanding remission and prevent the evolution to RA; however a short course of infliximab was not successful. Clinical prognostic markers were able to predict the evolution into the RA phenotype in this cohort. In summary, this thesis aimed to improve the management of patients in remission by objectively defining the remission state. Combinations of standard clinical and objective measures of remission are required to accurately diagnose remission and to identify patients who can safely withdraw therapy.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:588745 |
| Date | January 2011 |
| Creators | Saleem, Benazir |
| Publisher | University of Leeds |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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