ACR/EULAR Definitions of Remission Are Associated with Lower Residual Inflammatory Activity Compared with DAS28 Remission on Hand MRI in Rheumatoid Arthritis

Solano, A.; Ares, Jesús; Almirall, Míriam; Salman-Monte, Tarek Carlos; Maymó, Joan

doi:10.3899/jrheum.150849

Cited by 10 publications

(5 citation statements)

References 30 publications

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“…However, in the latter the disease remission was based on DAS28‐CRP < 2.6, 9 which is a less stringent cut‐off of SDAI remission adopted in our study. SDAI remission, as suggested by ACR/EULAR recommendations, 1 is associated with lowest risk of x‐ray progression and residual subclinical inflammation 2,10‐12 . Furthermore, 4 out of 6 ‘steroid‐yes’ patients stopped the first bDMARD for loss of efficacy but regained SDAI remission after switching to a bDMARD with a different mechanism of action.…”

Section: Discussionmentioning

confidence: 99%

Predictors of long‐term clinical remission in rheumatoid arthritis

Fornaro

Cacciapaglia

Lopalco

et al. 2020

Eur J Clin Investigation

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Aim Little is known about possible predictors of long‐term survival on biologic disease‐modifying antirheumatic drugs (bDMARD) after achievement of deep clinical remission in rheumatoid arthritis (RA) patients. We aimed at assessing factors associated with drug persistence of the first bDMARD in RA patients who achieved Simplified Disease Activity Index (SDAI) remission. Methods The clinical charts of RA patients beginning a first bDMARD were retrospectively reviewed, and those who achieved SDAI‐based remission were selected for this analysis. Drug retention rate and mean survival time (MST) were estimated using Kaplan‐Meier curves, and hazard ratios (HRs) of discontinuing bDMARD were estimated by multivariate Cox‐regression models. Results Eight‐six patients were on SDAI remission, and the survival rate of bDMARDs since ‘baseline‐time’ was 82.6% (MST = 77.8 (95% CI: 69‐86) months). Once on remission, patients not taking concomitant glucocorticoids had significantly higher survival rate (90.7%, MST = 86.3 (95% CI: 78‐95) months) than patients who continued to intake low dose of glucocorticoids (68.8%, MST = 56.9 (95% CI: 45‐69) months; P = .008). On the contrary, those patients assuming methotrexate (MTX) had significantly higher survival (87.7% (MST = 81.8 (95% CI: 73‐91) months) than patients who were not taking MTX (66.7% (MST = 55.3 (95% CI: 40‐71) months) (log‐rank 4.72, P = .03). After the achievement of disease remission, stopping glucocorticoids (HR 0.31, 95% CI: 0.10‐0.93) and methotrexate co‐therapy (HR 0.34, 95% CI: 0.12‐0.98) were independently associated with a lower risk of bDMARD discontinuation. Conclusions Among RA patients on clinical remission with a first bDMARD, those stopping glucocorticoids and continuing MTX had much longer survival on bDMARD.

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Section: Discussionmentioning

confidence: 99%

Predictors of long‐term clinical remission in rheumatoid arthritis

Fornaro

Cacciapaglia

Lopalco

et al. 2020

Eur J Clin Investigation

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“…On one hand, the lack of ultrasound activity predicts achievement and persistence of remission (33,34). On the other hand, there is a very high degree of confidence that residual synovial activity is a significant predictor for loss of remission (relapse, flare) and radiographic progression since controlled studies (35)(36)(37), meta-analyses (38,39), magnetic resonance imaging (MRI) studies (40)(41)(42)(43)(44)(45)(46), biological markers (14) and histology (47,48) have confirmed the cited ultrasound observations. The loss of remission tends to happen in the first year of follow-up (39), especially if treatment is withdrawn (49,50).…”

Section: Introductionmentioning

confidence: 72%

Clinical and ultrasound ankle involvement in rheumatoid arthritis in remission

Enache¹,

Popescu²,

Codreanu³

et al. 2019

Ro J Rheumatol.

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Objective. We aimed to evaluate the prevalence and differences of clinical and ultrasound involvement of ankles in rheumatoid arthritis (RA) patients in remission. Methods. RA patients were recruited in 2018 in the random order of presentation from the outpatient clinic. In the day of enrolment, all patients underwent clinical examination (by a senior rheumatologist, blind to other evaluations), inflammatory markers (e.g. C-reactive protein-CRP) and ankle ultrasound (performed and interpreted by a single rheumatologist with more than 7 years of experience). Results. The sample included 59 patients in DAS28CRP remission, 27 in SDAI remission and 20 in Boolean remission. Among these 3 categories of remission, overall clinical ankle involvement presented similar prevalence (revolving around 30%). On average, 77% of patients presented overall ultrasound ankle involvement among the 3 categories of remission, with similar frequencies of ankle joint synovial hypertrophy (SH; 33%), power Doppler (PD) positive joint SH (15%), ankle joint effusion (60%), ankle tenosynovitis (27%) and PD positive ankle tenosynovitis (15%). In the subgroup of RA patients in DAS28CRP remission, compared to patients without clinical or ultrasound ankle involvement, those with at least one involved ankle had a significantly higher median CRP (0.34 mg/dl versus 0.19 mg/dl, p = 0.042). Conclusion. Among RA patients in remission, regardless of its definition, clinical and ultrasound involvement of ankles is frequent. Clinical and ultrasound screening of ankles in RA patients in remission seems an appropriate strategy.

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“…However, whether or not more stringent remission criteria provide better clinical and radiographic outcomes in the long term is still under debate. Selecting more stringent remission criteria implies, on one hand, fewer joint counts and less subclinical activity [15][16]. On the other hand, the more stringent is our target, the more we will step up the therapy to achieve the goal, with a subsequent higher risk of adverse events [17].…”

Section: Discussionmentioning

confidence: 99%

Comparable Clinical and Radiographic Outcomes among DAS28-ESR-based Remission Criteria and SDAI, CDAI, and ACR/EULAR Boolean definitions in patients with Established Rheumatoid Arthritis in Clinical Practice. Observational Study of 5 years of Follow-Up

Ramírez¹,

Inciarte-Mundo²,

Cuervo³

et al. 2020

Preprint

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Objective To compare long-term clinical and radiographic outcomes among five sets of remission criteria [four clinical and one Ultrasound (US)-based] in a cohort of RA patients in a clinical care setting. Methods RA patients in remission (DAS28-ESR <2.6) were selected. Hand US assessments were performed, and serum levels of inflammation/angiogenesis biomarkers were determined at baseline. Changes in baseline treatment and radiographic progression, defined as the variation in the modified Sharp van der Heijde score (mSHS) at 5 years, were analyzed. To define remission, five different concepts were used, as follows: DAS28-ESR<2.6, SDAI<3.3, CDAI<2.8, Boolean criteria and score Power Doppler (PD)=0.Results Eighty-seven patients with DAS28-ESR<2.6 were included. One third fulfilled SDAI (33.3%), CDAI (31%) and Boolean (35.6%) remission criteria and 25.3% had no PD signal in the US evaluation. 26 patients (29.9%) changed the therapy, ranging from 13.6% (PD remission) to 33.3% (CDAI remission) (p=0.11). Serum levels of ANG (p=0.015) and TNFa (p=0.025) were significantly lower in patients with Boolean remission, whereas IL-18 levels were significantly lower in those with PD remission (p=0.049). Patients without PD in the US assessment had significantly lower mSHS erosion progression (p=0.014) at 5 years. Conclusions Patients with established RA in DAS28-ESR remission had comparable clinical and radiographic outcomes than SDAI, CDAI and Boolean definitions in a clinical care setting. US remission remained as the closest to structural damage abrogation.

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ACR/EULAR Definitions of Remission Are Associated with Lower Residual Inflammatory Activity Compared with DAS28 Remission on Hand MRI in Rheumatoid Arthritis

Abstract: Patients with RA in remission according to the SDAI and Boolean ACR/EULAR definitions showed lower levels of MRI-detected residual inflammation compared with DAS28.

Cited by 10 publications

References 30 publications

Predictors of long‐term clinical remission in rheumatoid arthritis

Predictors of long‐term clinical remission in rheumatoid arthritis

Clinical and ultrasound ankle involvement in rheumatoid arthritis in remission

Comparable Clinical and Radiographic Outcomes among DAS28-ESR-based Remission Criteria and SDAI, CDAI, and ACR/EULAR Boolean definitions in patients with Established Rheumatoid Arthritis in Clinical Practice. Observational Study of 5 years of Follow-Up

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