Very early rheumatoid arthritis as a predictor of remission: a multicentre real life prospective study

Abstract

BackgroundTo 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.Methods1795 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.ResultsDAS28 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).ConclusionsIn 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.

Early intervention in Crohn’s disease: towards disease modification trials

“…Consistent data were found in previous studies with infliximab, suggesting that the first 2 years of disease may be a valid window of opportunity for effective therapy in RA 28. Another study34 involving 711 patients with early RA diagnosed from over 1795 patients with symptoms of arthritis for less than 12 months showed that patients starting any treatment within 12 months since the onset of first symptoms or receiving disease-modifying agents (DMARDs) within 3 months from disease onset were significantly more likely to achieve disease remission (OR 2.03 (1.25–3.30) and 1.65 (1.06 to 2.55), respectively). The TICORA study35 showed the potential disease-modifying effect of intensive management versus routine care (mean disease duration: 16 months).…”

What is the evidence for the presence of a therapeutic window of opportunity in rheumatoid arthritis? A systematic literature review

“…Five of these eight studies showed a significant association between shorter symptom duration and increased frequency of remission 12 14 17 24. Of the four HQ studies, one study did not observe a significant association with symptom duration,30 two studies found a signification association,17 24 and one study assessed two cohorts of differently treated patients, showing a significant association in one but not in the other patient group 23.…”

The significance of the squeeze test to identify arthritis was underestimated or not?

“…Evidence indicates that early aggressive treatment results in greater improvement than therapy initiated later in rheumatoid arthritis (RA) disease 5 6. It’s very important that GPs could identify patients with suspected RA and refer them to rheumatological experts.…”