Prevalence of and predictive factors for sustained disease‐modifying antirheumatic drug–free remission in rheumatoid arthritis: Results from two large early arthritis cohorts

Abstract

Objective. Remission has become an attainable goal of rheumatoid arthritis (RA) treatment, especially since the advent of biologic antirheumatic therapy. Because little is known about patients who achieve disease remission with conventional treatment, we used 2 large independent inception cohorts to study the prevalence of and predictive factors for diseasemodifying antirheumatic drug (DMARD)-free sustained remission after treatment with conventional therapy.Methods. Remission of disease was assessed in 454 patients from the Leiden Early Arthritis Clinic (EAC) and in 895 patients from the British Early Rheumatoid Arthritis Study (ERAS) who fulfilled the American College of Rheumatology 1987 revised criteria for the classification of RA and were treated with conventional therapy. Sustained DMARD-free remission was defined as fulfilling the following criteria for at least 1 year: 1) no current DMARD use, 2) no swollen joints, and 3) classification as DMARD-free remission by the patient's rheumatologist. Predictive factors were identified by Cox regression analysis.Results. Sustained DMARD-free remission was achieved by 68 of 454 patients (15.0%) in the Leiden EAC and by 84 of 895 patients (9.4%) in the ERAS. Six factors were associated with sustained DMARD-free remission in both cohorts: acute onset, short symptom duration before inclusion, not smoking, little radiographic damage at baseline, absence of IgM rheumatoid factor (IgM-RF), and absence of HLA shared epitope alleles. In the ERAS, low disease activity at baseline was also predictive of remission. Multivariate analyses revealed symptom duration and the absence of autoantibodies (anti-cyclic citrullinated peptide 2 and IgM-RF) as independent predictors.Conclusion. Sustained DMARD-free remission in RA patients treated with conventional therapy is not uncommon. Symptom duration at presentation and the absence of autoantibodies are associated with sustained DMARD-free remission.

Identification of CXCL13 as a marker for rheumatoid arthritis outcome using an in silico model of the rheumatic joint

“…Disease remission was assessed as a second outcome measure in order to further substantiate the findings. Remission was defined in its most stringent form as the persistent absence of synovitis for Ն1 year after cessation of DMARD therapy and the identification of remission by the patient's rheumatologist (18). The remission status could be reliably ascertained in 152 of 155 RA patients.…”

Autoantibodies recognizing carbamylated proteins are present in sera of patients with rheumatoid arthritis and predict joint damage

“…Significant differences between ACPA-positive and -negative disease have been reported with respect to the contribution of genetic and environmental risk factors, as well as disease progression and remission (2)(3)(4)(5). Over the past few years important insight has been gained into the occurrence and etiophathology of ACPA-positive RA.…”

My Treatment Approach to Rheumatoid Arthritis

“…91,92 Although these patients may experience a flare-up of disease after observation for 3 to 6 months, in most, clinical remission is achieved again with resumption of therapy and there is no radiologic progression of disease. 91 Shorter symptom duration, absence of rheumatoid factor or ACPA, lower mean disease activity before remission, and less baseline disability are associated with attainment of sustained drug-free remission.…”

“…91 Shorter symptom duration, absence of rheumatoid factor or ACPA, lower mean disease activity before remission, and less baseline disability are associated with attainment of sustained drug-free remission. 92,93 After the first 1 to 2 years, the benefits of longterm corticosteroid therapy are often outweighed by the risks, including cataracts, osteoporosis and fractures, and potentially, cardiovascular disease. Beyond the early disease period, prednisone therapy primarily provides symptom relief and does not modify the course of disease progression.…”