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Extended report
Very early rheumatoid arthritis as a predictor of remission: a multicentre real life prospective study
  1. Elisa Gremese1,
  2. Fausto Salaffi2,
  3. Silvia Laura Bosello1,
  4. Alessandro Ciapetti2,
  5. Francesca Bobbio-Pallavicini3,
  6. Roberto Caporali3,
  7. Gianfranco Ferraccioli1
  1. 1Rheumatology Division, Catholic University of the Sacred Heart, Rome, Italy
  2. 2Rheumatology Department, Università Politecnica delle Marche, Ancona, Italy
  3. 3Rheumatic Disease Unit, School of Medicine, Policlinico San Matteo, Pavia, Italy
  1. Correspondence to Professor Gianfranco Ferraccioli, Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, CIC-Via Moscati 31, Rome 00168, Italy; gf.ferraccioli{at}rm.unicatt.it

Abstract

Background To assess whether, in the real world of three early arthritis clinics, early referral could allow the best outcome, ie, remission, to be reached, and whether reaching the outcome was more dependent on therapy than on disease duration or vice versa.

Methods 1795 patients with early arthritis (symptom duration ≤12 months) were entered into a prospective follow-up study. 711 patients (39.6%) were diagnosed with rheumatoid arthritis (RA). Each RA patient was treated according to the local algorithm, in three tertiary referral centres (representing a small province, a medium sized province and a metropolitan area, respectively). Remission, defined using the disease activity score in 28 joints (DAS28 <2.6) and American College of Rheumatology (ACR) criteria, was the major outcome evaluated at the 12-month follow-up.

Results DAS28 remission was achieved in 34.3% (range 19.5–49%) of RA patients and ACR remission in 15.2% (range 8.5–20.6%). At the multivariate logistic regression analysis only two variables emerged as predictors of the major outcome: being in very early rheumatoid arthritis (VERA; less than 12 weeks symptom duration at the time of first treatment) and being on disease-modifying antirheumatic drugs (DMARD) within 3 months from disease onset. Among RA patients in remission, only 10% of VERA subjects received an anti-TNF blocker compared with 32.2% of non-VERA patients (p=0.002, OR 0.23, 95% CI 0.09 to 0.64).

Conclusions In a real-world setting, the 12 weeks disease duration and an early intervention with DMARD represent the most significant opportunities to reach the major outcome, ie, remission of RA. Moreover, VERA represents a window of opportunity in terms of cost saving.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode

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