Is Achieving Remission Best for Patients With Early RA?

For patients with early rheumatoid arthritis (RA), function, quality of life, and other outcome measures are significantly improved if they achieve remission compared with achieving sustained low disease activity, researchers have found.

The study team analyzed demographic and clinical data from the Early Rheumatoid Arthritis Study (ERAS) and Early Rheumatoid Arthritis Network (ERAN), two large cohorts in the United Kingdom. Data was collected once at baseline and then once per year from 1986 to 2012.

The team defined remission as a mean disease activity score (RDAS) of less than 2.6 and low disease activity by a mean low disease activity score (LDAS) of 2.6 to 3.2 between years 1 and 5 of the study period. The researchers further examined sustained LDAS and sustained RDAS at years 1 and 2, as well as sustained Boolean remission (sBR) at years 1 and 2.

Multi-level models were used to assess changes in Health Assessment Questionnaire (HAQ), Short Form 36 Health Survey Questionnaire (SF-36), and total Sharp van der Heijde (SvdH) for each disease activity category.

The scores of 2701 patients were included in the study. Those who were categorized as having achieved mean RDAS (n=562) showed increasingly better scores compared with patients with mean LDAS (n=330) as measured by the HAQ, SF-36, and SvdH.

Patients with sustained RDAS (n=279) showed better scores on HAQ, the SF-36 Physical Component, Mental Component, and SvdH than patients with sustained LDAS (n=203).

Patients with sBR (n=93) showed the most significant differences in HAQ and SF-36 scores than patients with sustained LDAS (n=203).

The researchers concluded, “[W]e have shown highly significant and clinically meaningful associations between improved functional, [quality of life] and structural outcomes in early RA patients achieving remission compared with low disease activity up to year 5 in the ERAS/ERAN real-world inception cohorts … Analyses using the stricter Boolean remission criterion reveals more striking differences in function and [quality of life] outcome measures compared with patients achieving low disease activity.”

—Rebecca Mashaw

Reference:

Nikiphorou E, Norton SJ, Carpenter L, et al; ERAS and ERAN studies. Remission vs low disease activity: function, quality of life and structural outcomes in the Early Rheumatoid Arthritis Study and Network. Rheumatology. 2020;59(6):1272-1280. https://doi.org/10.1093/rheumatology/kez461