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AMSTERDAM -- Factors associated with not reaching remission during the first year of treatment of rheumatoid arthritis differed for women and men but related to lifestyle in both, a researcher reported here.

For women, the strongest factor for failing to achieve remission was obesity, with an odds ratio of 2.06 (95% CI 1.49-2.83), according to Susan Bartlett, PhD, of McGill University in Montreal.

In contrast, for men, current smoking was the strongest determinant, with an odds ratio of 3.45 (95% CI 2.06-5.77), she reported in a press briefing at the , sponsored by the European League Against Rheumatism.

Since treatment guidelines for rheumatoid arthritis have been formulated, the rates of remission have steadily increased. "In Canada 5 years ago, a little less than half of patients were not reaching remission, whereas last year, that rate increased to almost 70%. So we are doing much better at getting people to the target of therapy," she said.

But a group of patients remain in active disease, particularly women. In order to identify predictors of persistent disease, therefore, she and her colleagues analyzed data from the , a group that is very representative of a real-world population. Patients are usually enrolled with the first 6 weeks to 12 months of synovitis, and are treated according to the discretion of the treating rheumatologist.

The analysis included patients enrolled from 2007 to 2016, and included information about sociodemographics, what treatments were initially used, and other factors such as lifestyle and patient-reported pain, fatigue, and disability.

The sample included 1,628 patients, 72% of whom were women whose mean age was 55 and whose symptom duration was 6 months. The majority had moderate or high disease activity, and most received initial treatment with conventional disease-modifying antirheumatic drugs, usually methotrexate in dosages of 20 mg/week.

"So they were getting the therapy we'd want them to be getting according to available guidelines," she said.

Persistent disease was defined as a disease activity score above 2.6 at 12 months.

For women, factors other than obesity that were associated with an inability to reach remission included minority race (OR 1.46, 95% CI 1.07-2.00), lower education (OR 1.41, 95% CI 1.09-1.82), having comorbidities (OR 1.12, 95% CI 1.05-1.21), and fatigue (OR 1.05, 95% CI 1-1.09). Methotrexate use was associated with a greater likelihood of remission (OR 0.72, 95% CI 0.54-0.95).

"For men, it was a very different picture," she noted. Factors associated with a failure to reach remission included increased age (OR 1.48, 95% CI 1.22-1.79), symptom duration (OR 1.15, 95% CI 1.07-1.24), and pain (OR 1.11, 95% CI 1.03-1.20), while methotrexate use was beneficial (OR 0.55, 95% CI 0.33-0.90).

"The factors we thought might be related actually turned out not to be, including serology, the use of steroids, the presence of erosions at baseline, swollen joint counts, and disability scores," Bartlett said.

"I think these data are compelling, and represent a new and important message to rheumatologists and patients alike. The study shows the importance of getting the right treatment to people in a timely manner, but the data would suggest very strongly that if we want our medications to work as well as they can, we need to help people address their health behaviors," she said.

The press conference moderator, Robert Landewé, MD, of the University of Amsterdam, pointed out that the study doesn't necessarily mean that stopping smoking or losing weight will actually improve an individual patient's chance of reaching remission. Bartlett agreed, stating that those studies need to be done. "But this gives us the opportunity to broaden the conversation with patients," she concluded.