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Abstract
Background The Treat to Target and EULAR recommendations highlighted the need for achieving and maintaining remission in patients with early RA. We investigated if early RA patients with persistent moderate disease activity during the first year have in daily life a worst 3 to 5 year outcome than patients who achieved clinical remission.
Methods The ESPOIR cohort included 813 patients with early arthritis in at least 2 joints of less than 6 months disease duration. They were treated according to standard of care. Within the 573 patients who had a 5 year follow-up, 93 % fulfilled the ACR/EULAR criteria for RA. This study compared patients who were in persistent (at both the month 6 and month 12 visits) DAS28 remission (group.1) versus those who were in persistent (at both the M6 and M12 visits) moderate disease activity (DAS28>3.2 and ≤5.1)(group.2). The primary outcome measure was radiographic progression ((modified Total Sharp Score (mTSS)) at month 36. Secondary endpoints were clinical remission (DAS28, SDAI, ACR/EULAR), HAQ-DI, number of missed workdays at month 36 and 60. Fisher exact test was used to compare categorical variables and Kruskal-Wallis test for quantitative variables. Logistic regression analysis was performed to determine confounding factors of outcome.
Results Baseline characteristics were not significantly different between groups. Patients with persistent moderate disease activity during the first year, had greater radiographic progression, higher HAQ disability and number of missed days and lower rate of remission than those who achieved persistent remission (table).
Conclusions This study demonstrated that early RA patients with persistent moderate disease activity during the first year of the disease had a worst outcome than patients who achieved clinical remission. Moderate disease activity state had substantial impact on structure, function and health outcomes. Patients should benefit from more intensive therapeutic strategy.
Disclosure of Interest B. Combe: None Declared, I. Logeart Employee of: Pfizer, M. Belkacemi: None Declared, T. Schaeverbeke: None Declared, J.-P. Daures: None Declared, M. Dougados: None Declared