Background Recently, an American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) collaboration redefined remission in rheumatoid arthritis (RA).
Objectives To validate if remission predicts later good long-term outcome in terms of radiological progression and physical functioning in an early arthritis cohort.
Methods Patients from the Amsterdam Jan van Breemen Research Institute with RA (1987 ACR criteria), and not using biologicals, were included in the analysis. ACR/EULAR remission status (Boolean) was evaluated at 6 and 9 months. Long-term outcome included radiographs of hands and feet (scored by the Sharp- van der Heijde (SvH) method) and the health assessment questionnaire (HAQ). Good long-term outcome was defined as 1) stable X-ray score (change <1 in SvH), 2) low score on the HAQ (HAQ change ≤0 AND HAQ score consistently ≤0.5) and 3) both stable X-rays scores AND stable low HAQ scores between year 1 and 2 and between year 2 and 3. To analyze the ability of remission to predict good long-term outcome likelihood ratios and logistic regression were used.
Results We studied 359 patients with mean age 54 (SD 13), 70% female, median symptom duration 6 (3-7) months, and median swollen joint count and tender joint count 8 (4-11) and 6 (3-10), respectively. Mean DAS28 was 5,1 (1,2). Six percent of patients reached remission at 6 months, while 24% of all patients were in minimal disease activity state defined as DAS28<2.6. At 9 months these proportions were 11% and 25%, respectively. In the second year after inclusion 43% of the patients had radiographic progression (median progression 3 [2-8]). Between year 2 and 3 37% had radiographic progression (median progression 3 [2-6]). In 35% HAQ outcomes were good and in 20% both long-term outcomes were good between year 1 and 2. Between year 2 and 3 these proportions were 32% and 21%, respectively. Patients in remission at 9 months, but not at 6 months, had a significantly increased likelihood of a good outcome in terms of stable HAQ and stable HAQ/Sharp between year 1 and 2 (table 1). Furthermore, remission at 6 as well as at 9 months was significantly predictive for good outcome in terms of stable HAQ and stable HAQ/Sharp between year 2 and 3 (table 1).
Conclusions In this early RA cohort not on biological treatment, good long-term outcome in terms of radiological progression and physical functioning between year 1 and 2 after inclusion was predicted by remission at 9 months, and between year 2 and 3 after inclusion by remission at 6 as well as at 9 months.
Disclosure of Interest None Declared
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