Background The ACR/EULAR remission criteria were validated against their potential to predict future prognosis of rheumatoid arthritis (RA) . Sustained remission was not studied, but is likely to be an even stronger predictor of RA prognosis. Furthermore, the patients in the validation study mainly had established RA, whereas results might be different for early RA patients.
Objectives To investigate whether remission at single and consecutive visits predicts good outcome in early RA.
Methods The presence of remission according to ACR/EULAR and other criteria (Boolean clinical, CDAI, DAS, DAS28, RAPID3) was assessed in early RA patients during the first year of the COBRA-light trial [2,3]. Likelihood ratios were used to assess whether meeting the remission criteria at single visits (13, 26, 39 or 52 weeks) and consecutive visits (13+26, 26+39 or 39+52 weeks) predicted good outcome in the second year (52–104 weeks). Good outcome was defined for function (HAQ consistently ≤0.5 and no deterioration), radiographic damage progression (no deterioration in Sharp-Van der Heijde scores) and both (“overall good outcome”).
Results Of the original 164 trial patients, 144 had evaluable data. In the second year, good functional outcome was observed in 35%, good radiographic outcome in 79%, and both in 28% of the patients. Highest sustained remission rates at 13+26, 26+39, and 39+52 weeks were observed for DAS28, followed by DAS, SDAI, CDAI, RAPID3, Boolean clinical and Boolean criteria (Figure 1). Almost all criteria predicted good functional and good overall outcome, at both single and consecutive visits; only single DAS remission did not significantly predict good overall outcome (p=0.07). Sustained remission periods resulted in higher likelihood ratios than remission at single visits (Table 1). None of the criteria predicted good radiographic outcome.
Conclusions Early RA patients who reach remission according to ACR/EULAR and other criteria during short or sustained periods are likely to retain good physical function in the subsequent months. Sustained remission periods are a stronger predictor than remission at single visits. However, in the setting of low overall damage progression, (sustained) remission was not predictive of good radiographic outcome.
Felson, Arthritis Rheum 2011;
Den Uyl, ARD 2014;
Ter Wee, ARD 2015.
Disclosure of Interest N. Konijn: None declared, L. van Tuyl: None declared, M. Boers Consultant for: MundiPharma, Pfizer, D. Den Uijl: None declared, M. ter Wee: None declared, P. Kerstens: None declared, A. Voskuyl: None declared, D. van Schaardenburg: None declared, M. Nurmohamed: None declared, W. Lems Grant/research support from: This study was supported by an unrestricted grant from Pfizer