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Very early rheumatoid arthritis is the major predictor of major outcomes: clinical ACR remission and radiographic non-progression
  1. Silvia Bosello,
  2. Anna Laura Fedele,
  3. Giusy Peluso,
  4. Elisa Gremese,
  5. Barbara Tolusso,
  6. Gianfranco Ferraccioli
  1. Division of Rheumatology, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
  1. Correspondence to Gianfranco Ferraccioli, Division of Rheumatology, School of Medicine, Catholic University of the Sacred Heart, CIC-Via Moscati 31, 00168 Rome, Italy; gf.ferraccioli{at}


Objectives To identify predictors of clinical remission as well as of no x-ray progression in a cohort of early rheumatoid arthritis (ERA) treated with a tight-control protocol.

Methods A total of 121 consecutive patients with ERA were treated to reach European League Against Rheumatism (EULAR) and/or American College of Rheumatology (ACR) clinical remission with methotrexate (MTX) for 3 months, then with a combination with anti-tumour necrosis factor if the patient did not achieve a 44-joint Disease Activity Score (DAS44) ≤2.4. At baseline and after 12 months all the patients had hand and foot joint radiographs. Very early rheumatoid arthritis (VERA) was defined as a disease with symptoms of less than 12 weeks.

Results In all, 46.3% of the patients reached DAS remission and 24.8% achieved ACR remission. More than 60% of patients reached remission with MTX. Male sex and an erythrocyte sedimentation rate <35 mm/h at onset arose as significant predictors of EULAR remission, while VERA disease was the only predictor of ACR remission. At baseline, 28.1% of the patients were erosive. Multivariate analysis demonstrated that the only independent predictor of erosiveness was ‘not having VERA disease’. After 12 months, VERA was the only factor predicting a lack of new erosions.

Conclusions VERA represents the best therapeutic opportunity in clinical practice to achieve a complete remission and to stop the erosive course of rheumatoid arthritis.

This paper is freely available online under the BMJ Journals unlocked scheme, see

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Catholic University of the Sacred Heart Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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