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We read the article of Scirè et al with interest,1 evaluating the association between remission and mortality in patients with inflammatory polyarthritis. This study shows that patients achieving remission early in the disease course have an improved survival rate compared with patients never achieving remission. Based on this observation, the authors conclude that achieving remission early in the disease influences the long-term outcome. The question arises which processes underlie their observation. Rheumatoid arthritis (RA) has been associated with an increased mortality risk, which has been attributed to the effects of long-term inflammation.2 We hypothesised that the observation in which patients with remission have an improved survival rate might actually be driven by the association between prolonged inflammation and increased mortality risk.
We addressed this hypothesis by taking advantage of long-term outcomes of 556 patients with early undifferentiated arthritis or RA that were included in the Leiden Early Arthritis Clinic between 1993 and 1998.3 Treatment in this era was delayed and disease-modifying antirheumatic drugs (DMARDs) were mild. We previously observed that patients included in this era had an increased …