Rapid 1-Year Remission Linked to Better Structural Damage Outcomes in RA

The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

CHICAGO — To protect joint damage in early rheumatoid arthritis (RA), remission is a crucial therapeutic goal, and remission criteria can predict radiological prevention, according to research presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24, in Chicago, Illinois.

Researchers in this Belgian cohort study analyzed the newly pathological joints and radiographic progression of 133 patients with early RA during 5 years of follow-up and correlated participants’ Sharp/Van der Heijde (SVdH) scoring with other indices of clinical remission seen in the first year. Mean change from baseline (95% CI) to 5 years SVdH scoring was measured by 28-joint count Disease Activity Score (DAS28), Simple Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) Boolean remission scores at 3, 6, and 12 months. SVdH scores of 0 at baseline and follow-up scores >1 were used to define newly pathological joints.

All participants (100 women, 33 men) were treatment-naive to disease-modifying antirheumatic drugs (DMARDs) and had a mean DAS28-C-Reactive Protein (CRP) score of 4.89±1.3, a mean SDAI of 28.4±15.5, a mean CDAI of 25.8±14.8, and a mean SVdH of 6±14. Participants with a SVdH score delta of ≤10 (n=90) were categorized as “x-ray stable,” and participants with a SVdH score delta of >10 (n=43) were categorized as “x-rayprogressive.” Baseline erosion and anti-citrullinated protein antibodies (ACPA) were predictably more prevalent among the participants who were x-ray progressive, with no significant differences observed between groups in baseline DAS28-CRP, SDAI, CDAI, CRP, Health Assessment Questionnaire, smoking status, or swollen joint count.  

At 6 months, the percentage of participants reaching Boolean remission scores for DAS28-CRP, SDAI, and CDAI were statistically different between the x-ray stable and x-ray progressive groups. The most stringent test with a statistical difference in Boolean remission rates was also observed at 3 months (specificity 90.5%, sensitivity 32.2%). No significant clinical response difference was observed between the subgroups of participants who did or did not develop new pathological joints.

Study investigators conclude that “these results demonstrate that remission is an important therapeutic goal to protect joint damage in [early] RA. All remission criteria were able to predict the radiological prevention. The identification of a new pathologic joint is not associated with lack of response.”

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Reference

Legrand J, Kirchgesner T, Sokolova T, Vande BV, Durez P. Rapid remission during the first year in early active rheumatoid arthritis is associated with better 5 years structural damage outcomes. Presented at: 2018 ACR/ARHP Annual Meeting; October 19-24, 2018; Chicago, Illinois. Abstract 2987.

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