Background/Purpose:
Finnish national combination treatment trials have demonstrated excellent
outcomes in patients with ERA including 90% of patients reaching DAS28
remission at 6 months. Whether similar results are reached in clinical praxis are not known. We herein report characteristics, disease
activity and DAS28 remission rates at 6 months in ERA patients treated in 5
Finnish outpatient clinics.

Methods:
FIN-ERA is the first national multicenter observational cohort of adult
patients with early inflammatory arthritis, clinically diagnosed as RA between
Oct 2011 and Sep 2014. Data comprising demographic, clinical and treatment
characteristics were collected as a part of routine care. Treatment
decisions were made by treating rheumatologists with cooperation with the
patient. Finnish treatment recommendations emphasize early and active
therapy with combination of csDMARDs and prednisolone
starting at the diagnosis, and unlimited glucocorticoid injections to all
swollen joints.

Results: Out
of 605 recruited patients, 566 completed baseline, 3 and 6
months visit and had full data for disease activity score (DAS28-3) with ESR.
In the entire cohort, the mean age was 56±16 yrs, the
median (IQR) duration of symptoms was 6(3,11) mo, rheumatoid factor (RF) and anti cyclic-citrullinated
peptide antibodies (anti-CCP) were evident in 68% and 69%, respectively.
At baseline, a total of 23% of patients had radiographic erosions. A total of
484 (86%) fulfilled the ACR/EULAR 2010 classification criteria for RA at baseline.
Figure 1 represents the mean DAS28-3 for RA patients at baseline, 3 mo and at 6 mo
at FIN-ERA clinics A-E. The respective mean HAQ and DAS28 (with ESR, 4
variables,DAS28-4) at baseline were 1.0±0.7 (data for
83%) and 4.3±1.4 (data for 88%). The corresponding values for HAQ and DAS28-4
at 6 mo were 0.4±0.5 (data
for 86%) and 2.1±1.1 (data for 93%). A total of 73% met DAS28-4 remission at 6
mo. Remission rates were similar in patients classified as undifferentiated
arthritis (14% of the cohort), and did not differ significantly according to
serology. A total of 57% of ERA patients were in sustained DAS28-4 remission at
3 and 6 mo. Figure 2 represents DAS28-4 remission rates at 3 and 6 mo at 5 FIN-ERA clinics. In a multivariate model, lower
disease activity at baseline and male gender predicted remission
(DAS28-3<2.6) at 6 mo,
while age, RF/anti-CCP, erosiveness, or clinic
remained statistically unsignificant. A total of 75% received
MTX based combination csDMARD therapy at baseline,
and 1.4% bDMARDs within 6 mo.

Conclusion: A
majority of ERA patients reach early and sustained DAS28 remission in Finland.