Background The ESPOIR cohort of French early arthritis patients who received routine care was analyzed for remission status 1 year after baseline and reviewed for radiographic progression 1 year later (24 months after baseline) according to 6 remission criteria, including 2 based primarily on self-report, RAPID3≤3 (routine assessment of patient index data) and RAPID3 ≤3 and ≤1 swollen joint (RAPID3≤3+SJ≤1).
Objectives To analyze radiographic progression over 1 year in the ESPOIR cohort, according to whether or not patients were in remission 1 year earlier, using 6 different remission criteria: ACR Boolean criteria; simplified disease activity index (SDAI) ≤3.3; clinical disease activity index (CDAI) ≤2.8; disease activity score (DAS28) <2.6; RAPID3 ≤3; and RAPID3≤3+SJ≤1.
Methods ESPOIR includes French early arthritis patients who received routine care. Remission was assessed at 12 months after baseline, according to 6 criteria: Boolean, SDAI≤3.3, CDAI≤2.8, DAS28<2.6, RAPID3≤3, and RAPID3≤3+SJ≤1. The numbers of patients whose radiographic progression according to the Sharp van der Heijde (SvdH) score was ≥1, ≥5 [the smallest detectable difference (SDD)]1, ≥10 and ≥20 units at 24 months (12 months after the remission assessment) were analyzed, according to whether patients had been in remission 12 months earlier for each of the 6 criteria, using chi-square tests for statistical significance.
Results Radiographic progression ≥1 SvdH unit at 24 months was seen in 28.9%>32.7% of patients who were in remission vs. 31.3%>32.3% not in remission 1 year earlier, with similar results for each of the 6 remission criteria; the negligible differences were not statistically significant, and indicated that 2/3 of patients had no radiographic progression whatsoever. Progression ≥5 units (SDD) was seen in 10.1%>11.8% of patients in remission and 13.0%>13.8% of patients not in remission; differences were not statistically significant (p>0.3), but showed some separation according to earlier remission status. Progression ≥10 units was seen in 1.4-4.3% of patients in remission versus 6.5-7.6% of those not in remission, a 2-fold difference; only differences by DAS28 and RAPID3≤3+SJ≤1 were statistically significant (p<0.05). Progression ≥20 units was seen in 0.1-1.1% of those in remission versus 2.6-3.1% of those not in remission, a 3-fold difference, statistically significant for SDAI, CDAI, DAS28 and RAPID3≤3+SJ≤1. No differences were seen among the 6 remission criteria examined for SvdH radiographic scores.
Conclusions Very little radiographic progression is seen in patients receiving routine care in recent years, but differences were seen as radiographic criteria became more stringent. Although differences are not or only marginally significant, a 2-fold higher likelihood of progression at 24 months is seen in ESPOIR patients who were not in remission at 12 months with a 10 SvdH unit cutpoint, and 3-fold difference with 20 units. No differences were seen according to any of the 6 remission criteria.
Arthritis Rheum 2002;46:913–20
Disclosure of Interest None declared
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