ArticleRMD open2018
Mental health, fatigue and function are associated with increased risk of disease flare following TNF inhibitor tapering in patients with rheumatoid arthritis: an exploratory analysis of data from the Optimizing TNF Tapering in RA (OPTTIRA) trial.
Article in RMD open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Longitudinal effects of affective distress on disease outcomes in rheumatoid arthritis: a meta-analysis and systematic review.Rheumatology international · 2024Pooled it
- Rheumatoid arthritis in crisis: investigating the impact of stress on RA flares during the COVID-19 pandemic.Clinical rheumatology · 2026Article
- Self-management behaviors do not affect remission but mediate between mental health and disease outcomes in a longitudinal study of rheumatoid arthritis.Rheumatology international · 2025Article
- Ongoing shielding behavior one year post COVID-19: results from a longitudinal study of patients with inflammatory arthritis.Rheumatology international · 2024Article
- Flare during tapering of biological DMARDs in patients with rheumatoid arthritis in routine care: characteristics and predictors.RMD open · 2022Article
- Interleukin 6, interleukin 17, disease-related and contextual factor association with depression, and its severity in patients with rheumatoid arthritis.Clinical rheumatology · 2021Article
- Predictors of Flares in Patients with Rheumatoid Arthritis Who Exhibit Low Disease Activity: A Nationwide Cohort Study.Journal of clinical medicine · 2020Article
- Management of Fatigue in Rheumatoid Arthritis.RMD open · 2020Review
- Satisfaction of Patients and Physicians with Treatments for Rheumatoid Arthritis: A Population-Based Survey in China.Patient preference and adherence · 2020Article
- The effect of deep or sustained remission on maintenance of remission after dose reduction or withdrawal of etanercept in patients with rheumatoid arthritis.Arthritis research & therapy · 2019Article
- Depression and the risk of rheumatoid arthritis.Current opinion in rheumatology · 2019Review
- Factors of depression among patients with rheumatoid arthritis.Reumatologia · 2018Article
Corrections and comments
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
backgroundTapering of anti-tumour necrosis factor (TNF) therapy appears feasible, safe and effective in selected patients with rheumatoid arthritis (RA). Depression is highly prevalent in RA and may impact on flare incidence through various mechanisms. This study aims to investigate if psychological states predict flare in patients' dose tapering their anti-TNF therapy.
methodsThis study is a post-hoc analysis of the Optimizing TNF Tapering in RA trial, a multicentre, randomised, open-label study investigating anti-TNF tapering in RA patients with sustained low disease activity. Patient-reported outcomes (Health Assessment Questionnaire, EuroQol 5-dimension scale, Functional Assessment of Chronic Illness Therapy fatigue scale (FACIT-F), 36-Item Short Form Survey (SF-36)) were collected at baseline. The primary outcome was flare, defined as an increase in 28-joint count Disease Activity Score (DAS28) ≥0.6 and ≥1 swollen joint. Discrete-time survival models were used to identify patient-reported outcomes that predict flare.
resultsNinety-seven patients were randomised to taper their anti-TNF dose by either 33% or 66%. Forty-one patients flared. Higher baseline DAS28 score was associated with flare (adjusted HR 1.96 (95% CI 1.18 to 3.24), p=0.01). Disability (SF-36 physical component score), fatigue (FACIT-F) and mental health (SF-36 mental health subscale (MH)) predicted flare in unadjusted models. In multivariate analyses, only SF-36 MH remained a statistically significant predictor of flare (adjusted HR per 10 units 0.74 (95% CI 0.60 to 0.93), p=0.01).
conclusionsBaseline DAS28 and mental health status are independently associated with flare in patients who taper their anti-TNF therapy. Fatigue and function also associate with flare but the effect disappears when adjusting for confounders. Given these findings, mental health and functional status should be considered in anti-TNF tapering decisions in order to optimise the likelihood of success. TRIAL REGISTRATION NUMBERS: EudraCT Number: 2010-020738-24; ISRCTN: 28955701; Post-results.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.