Background Treat-to-target strategies with achievement of clinical remission within 6 months minimize radiographic progression and physical impairment in RA.(1) The preferred target, ACR/EULAR Boolean remission criteria, was developed to optimize a combination of radiographic and functional outcome.(2) However, clinical remission does not exclude subclinical inflammation, associated with progression of radiographic damage.(3)
Objectives Our aim was to assess the association between definitions of remission at six months, including absence of ultrasound inflammation, and future absence of joint damage and physical disability.
Methods DMARD-naïve RA patients with <2 years since first swollen joint and indication for DMARD treatment were included in the treat-to-target ARCTIC trial.(4) Patients followed with ultrasound (treatment target DAS <1.6 + SJC44=0 + no PD signal in 32 joints) were analyzed. We assessed remission at 6 months according to the following criteria: DAS-ESR, DAS28-ESR, SDAI, CDAI, ACR/EULAR Boolean remission (based on 44 joints), no swollen joints (SJC44), no ultrasound PD signal in any joint (0–96), and minimal greyscale (GS) score (GS ≤2, 0–96). Radiographs were scored by two readers using van der Heijde-Sharp score, with no radiographic progression defined as <1 unit change between 12–24 months based on the average score of the readers. We defined good outcome as a combination of no radiographic progression and physical function (PROMIS) ≥ median of the general population.(2) Odds ratios of reaching both outcomes were calculated according to various remission states at 6 months.
Results Of the 103 patients included, 74% were female, mean [SD] age 51.4 [12.9], disease duration 6.7 [5.3] months, DAS 3.5 [1.1] and PROMIS 39 . Median [25th, 75th percentile] radiographic progression 12–24 months was 0.49 [0.0, 1.03], and 71% had no progression. DAS remission was achieved by 59% at the 6-month visit, while 42% were in ACR/EULAR Boolean remission. Patients in ACR/EULAR Boolean remission had significantly higher odds ratio of no radiographic progression from 12–24 month than patients not in Boolean remission, as had patients with no PD signal or minimal GS findings (fig). Being in remission at six months according to each composite score separately or ACR/EULAR Boolean remission (OR 7.52, CI 3.06 –18.49) predicted a good outcome, while criteria based on ultrasound or no swollen joints did not (fig). No statistically significant association was found between remission according to composite scores and radiographic progression (Fig).
Conclusions Our data show that being in ACR/EULAR Boolean remission after six months of treat-to-target therapy increases both the odds of no radiographic progression and good physical function, supporting current recommendations stating that ACR/EULAR remission should be the preferred treatment target in early RA.(1) Additionally, our analyses support that absence of ultrasound inflammation is associated with no future radiographic progression.
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Disclosure of Interest N. Sundlisater: None declared, A.-B. Aga: None declared, I. Olsen: None declared, H. Hammer Consultant for: AbbVie, Pfizer, BMS, Roche, UCB, T. Uhlig: None declared, D. van der Heijde: None declared, T. Kvien: None declared, S. Lillegraven: None declared, E. Haavardsholm Grant/research support from: AbbVie, Pfizer, MSD, Roche, UCB