To investigate how psychosocial aspects affect the probability of achieving sustained remission in early RA, and to explore the directionality of this relationship.
Data were analyzed from the randomized controlled CareRA-trial. Sustained remission was defined as continued DAS28-CRP <2.6 from weeks 16 to 104. Patients completed the Short Form 36 (SF-36), Revised Illness Perception Questionnaire (IPQ-R) and Utrecht Coping List (UCL). These psychosocial variables were studied at baseline and week 16 as predictors of sustained remission with logistic regression. Next, subgroups of patients in remission at week 16 were identified by Latent Profile Analysis (LPA) based on these psychosocial indicators. Time to first loss of remission was then compared between groups by Cox-proportional-hazards regression. Finally, directionality of associations between psychosocial indicators and DAS28-CRP was explored with cross-lagged panel models (CLPM).
Sustained DAS28-CRP-remission was associated with higher SF-36-scores and less passive coping at baseline, and with higher SF-36-scores and more positive IPQ-R-outcomes at week 16. Among patients in DAS28-CRP-remission at W16 (n=287), two subgroups were identified: a low-psychosocial-burden group (n=231/287) and high-psychosocial-burden group (n=56/287). The low-psychosocial-burden group retained remission longer (HR 0.51 [0.35-0.73]). In the CLPM, temporal relationships between psychosocial wellbeing and DAS28-CRP were complex, bidirectional and disease-phase dependent.
Suboptimal psychosocial wellbeing and negative illness perceptions predicted lower probability of sustained remission in an early RA cohort. Illness perceptions appeared to become more clinically relevant with time. Finally, one-in-five patients showed worse psychosocial outcomes despite early remission, and these patients tended to lose remission earlier.