Short and sustained periods of ACR/EULAR remission predict good functional outcome, but do not predict good radiographic outcome in early rheumatoid arthritis patients with low overall damage progression

OBJECTIVE: To investigate whether remission at single and consecutive visits predicts good outcome in early rheumatoid arthritis (RA).

METHODS: The presence of remission according to ACR/EULAR and other criteria (Boolean clinical, CDAI, DAS, DAS28, RAPID3) was assessed in early RA patients during the first year of the COBRA-light trial. Likelihood ratios were used to assess whether meeting the remission criteria at single visits (13, 26, 39 or 52 weeks) and consecutive visits (13 + 26, 26 + 39 or 39 + 52 weeks) predicted good outcome in the second year (52-104 weeks). Good outcome was defined for function (HAQ consistently ≤0.5 and no deterioration), radiographic damage progression (no deterioration in Sharp-Van der Heijde scores) and both ('overall good outcome').

RESULTS: Of the original 164 trial patients, 144 had evaluable data. In the second year, good functional outcome was observed in 35%, good radiographic outcome in 79%, and both in 28% of the patients. Almost all criteria predicted good functional and good overall outcome, at both single and consecutive visits; only single DAS remission did not significantly predict good overall outcome (p=0.07). Sustained remission periods resulted in higher likelihood ratios than remission at single visits. None of the criteria predicted good radiographic outcome.

CONCLUSION: Early RA patients who reached remission according to ACR/EULAR and other criteria during short or sustained periods were likely to retain good physical function in the subsequent months. Sustained remission periods were a stronger predictor than remission at single visits. However, in the setting of low overall damage progression, (sustained) remission was not predictive of good radiographic outcome. This article is protected by copyright. All rights reserved.