Background The relevant elements to evaluate health states in RA should include (1):
a) Remission according to the new criteria of ACR / EULAR
b) A criterion representing good functional ability: HAQ ≤0.5 and HAQ deterioration ≤0.25
c) A criterion representing structural damage: absence of progression of the Sharp score over 1 year
The concept of favorable outcome could then be defined by the association of these 3 elements. An alternative definition of favorable outcome includes only the last 2 criteria: function + structure.
Objectives To describe patients with favorable outcome at 1 year and with sustained favorable outcome over 3 years in early arthritis (EA) in daily clinical practice.
Methods - Patients: the French cohort ESPOIR (at least 2 swollen joints for less than 6 months and suspicion of RA) fulfilling the ACR-EULAR criteria for RA at baseline.
- Data collected: at baseline, patients’ characteristics; every 6 months, bio-clinical variables and yearly, X-rays.
- Analysis: The characteristics and health status of patients with favorable outcome (according to the two definitions, ie using 2 and 3 criteria) at 1 year, with repeated favorable outcome (favorable outcome at >1 time-point) and with sustained favorable outcome (favorable outcome at 2 consecutive time-points) over 3 years were analyzed.
Results 643 patients were analysed (mean age of patients 48±12 years; 78% were women; mean DAS28 5.4±1.2). At 1 year, 98 (17%) were in remission according to the Boolean ACR/EULAR definition, 340 (59%) had favorable function criterion and 374 (70%) had no structural progression. In all, 215 (40%) presented favorable outcome using the 2 criteria (function+structure) and 71 (13%) presented favorable outcome using the 3 criteria (clinical remission+function+structure).
Over 3 years, 97 patients presented repeated favorable outcome using 2 criteria and 29, repeated favorable outcome using 3 criteria. Only 48 had sustained favorable outcome using 2 criteria and 14 sustained favorable outcome using 3 criteria (table).
Conclusions The goals of treatment in EA are more and more ambitious, explaining the low proportion of patients with favorable outcome and even more with sustained favorable outcome. The most limiting criteria is clearly the Boolean ACR/EULAR remission, raising concerns about the place of patient reported outcomes.
Felson DT et al. Ann Rheum Dis 2011; 70(3):404-13
Disclosure of Interest None Declared
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