Background Modern treatment of early RA is targeted towards remission. Sustained remission is viewed as more beneficial to the patient than remission at one time point, also with regards to inhibition of joint damage,(1, 2) but data are limited. Treat-to-target studies yielding high rates of sustained remission have improved the ability to assess the relationship between sustained remission and joint damage.
Objectives To assess the frequency of no radiographic progression among early RA patients in sustained remission defined by established criteria and in patients with sustained absence of inflammation assessed by ultrasound.
Methods RA patients with <2 years from first swollen joint who were DMARD naive with indication for DMARD treatment were included in the ARCTIC trial.(3) Patients in the ultrasound arm aiming for DAS <1.6, no swollen joints and no ultrasound power Doppler (PD) signal were included in the current analyses. Several definitions of sustained remission (12–24 months) were compared; DAS-ESR, DAS28-ESR, SDAI, CDAI, ACR/EULAR Boolean remission (based on 44 joints), no swollen joints (44SJC), no ultrasound PD signal in any joint (0–96) and minimal total ultrasound greyscale (GS) score (defined as GS ≤2, 0–96). No radiographic progression (12–24 months) was defined as <1 unit change in the van der Heijde modified Sharp score (vdHSS). Positive and negative likelihood ratios of no radiographic progression were estimated for patients in sustained remission per definition.
Results Of 103 patients, 76 (74%) were female, mean [SD] age was 51.4 [12.9] years, disease duration 6.7 [5.3] months and DAS 3.5 [1.1]. The median [25th, 75th percentile] change in vdHSS 12–24 months was 0.49 [0.0, 1.03], and 73 (71%) patients had no radiographic progression. Sustained remission was reached by 23–61% according to the different criteria. Among patients in sustained remission, comparable proportions of patients did not progress radiographically across the different criteria (74–89%), with the most favorable result for minimal GS score (Table). Patients with sustained no PD or minimal GS score had an increased likelihood of no radiographic progression during the concurrent year (Table), but still rather weak to be useful in an individual patient. Based on the low LR+ none of the criteria identifies patients without radiographic progression very well; likewise, as the LR- is relatively high for all definitions, not being in remission does not change the probability of ongoing radiographic progression substantially.
Conclusions In this treat-to-target early RA study, sustained remission rates were generally high and radiographic progression limited. None of the sustained remission criteria were able to exclude concurrent radiographic progression. Absence of ultrasound inflammation performed best of the definitions assessed.
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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
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