Remission criteria with and without the inclusion of patient global assessment (PGA) are similarly predictive of radiographic progression in early arthritis, according to study results published in Arthritis Care & Research.1

Current remission criteria for rheumatoid arthritis (RA) are based on a composite of multiple disease measures, including PGA; however, the association between PGA and disease outcomes is unclear.

Using data from the French multicenter observational ESPOIR cohort, the researchers aimed to compare the association between achieving composite remission criteria with and without PGA values with structural progression in patients with early arthritis.

Remission criteria, evaluated at 6 and 12 months, were Boolean-based on 4 variables (4v-remission), including ≤1 swollen 28-joint counts, ≤1 tender 28-joint counts, C-reactive protein levels (CRP) ≤1 mg/dL, and a PGA value ≤1/10. Progression of structural damage was assessed by radiography of the hands, wrist, and feet at baseline and at 3 years, and quantified using the Sharp-van der Heijde score (SHS).


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A total of 520 patients (77% women; mean age, 49.0 years) were included in the analysis. Using the standard 4v-remission criteria, 35 patients (7%) attained remission at 6 and 12 months. An additional 62 patients (12%) achieved remission criteria when PGA values were excluded, with a total of 97 patients (19%) achieving 3 variable-based remission (3v-remission).

Mean structural progression for the full cohort over 3 years was 8.2±10.5 SHS units. Within the 4v- and 3v-remission groups, the mean change in SHS units was 4.0±6.0 and 5.2±6.6, respectively; mean radiographic progression among those who did not achieve either remission cutoff was 9.0±11.1 SHS units.

Radiographic progression was observed in 29% of patients in the 4v-remission group and 39% in the 3v-remission group.

Compared with patients who did not experience remission, patients in the 4v-remission group were less likely to experience radiographic progression (odds ratio [OR], 0.32; 95% CI, 0.15-0.68). There was no statistically significant difference in the likelihood of progression in the 4v-remission group vs the PGA-exclusion group (OR, 0.49; 95% CI, 0.20-1.18) or in the 3v-remission cohort (OR, 0.62; 95% CI, 0.27-1.44).

Multivariate analysis of remission components indicated that swollen 28-joint count and CRP levels were predictive of change in SHS at 3 years. When PGA was removed, tender 28-joint count was negatively associated with joint damage.

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Investigators noted that the evaluation of remission at just 2 time points may not be fully reflective of disease control over the study period.

“[B]oth [4 variable] and [3 variable] targets appear useful when aiming at structural nonprogression,” they concluded. “[M]ore research is needed on the link between PGA, the disease process in RA and radiographic progression.”

Disclosures: Several authors declare affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

Ferreira RJO, Fautrel B, Saraux A, et al. Patient global assessment and radiographic progression in early arthritis: 3-year results from the ESPOIR cohort [published online April 27, 2020]. Arthritis Care Res (Hoboken). doi:10.1002/acr.24237