Background/Purpose:

The Treat to Target and EULAR recommendations highlighted the need for achieving and maintaining remission in patients with early RA. We investigated if early RA patients with persistent moderate disease activity during the first year have in daily life a worst 3 to 5 year outcome than patients who achieved clinical remission.

Methods:

The ESPOIR cohort included 813 patients with early arthritis in at least 2 joints of less than 6 months disease duration. They were treated according to standard of care. Within the 573 patients who had a 5 year follow-up, 93 % fulfilled the ACR/EULAR criteria for RA. This study compared patients who were in persistent moderate disease activity (DAS28>3.2 and ≤ 5.1) at both month 6 and month 12 visits  (group.1) versus those who were in sustained DAS28 remission at both  M6 and M12 visits  (group.2). The primary outcome measure was radiographic progression ((modified Total Sharp Score (mTSS)) at month 36. Secondary endpoints were clinical remission (DAS28, SDAI, ACR/EULAR), HAQ-DI, number of missed workdays at month 36 and 60. Fisher exact test was used to compare categorical variables and Kruskal-Wallis test for quantitative variables. Logistic regression analysis was performed to determine confounding factors of outcome.

Results:

Baseline characteristics were not significantly different between groups. Patients with persistent moderate disease activity during the first year, had greater radiographic progression, higher HAQ disability and number of missed workdays and lower rate of remission at 3 to 5 years than those who achieved early sustained remission (table). 

3-year Outcome variable	Group 1 n=107	Group 2 n=155
mTSS	16.1±14.9**	11.2 ± 11.8
r mTSS from day 0	10.8±6.5~	6.5±8.9
rmTSS >5 (%)	56.0°	39.2
DAS28 remission (%)	27.4*	81.0
SDAI remission (%)	13.8*	56.0
ACR/EULAR remission (%)	10.3*	50.4
HAQ-DI	0.68± 0.61*	0.21± 0.38
Missed workdays (n)	157.3± 226.2*	30.9± 75.9
5-year outcome variable	Group 1 n=107	Group 2 n=155
DAS28 remission (%)	39.2*	80.7
SDAI remission (%)	24.0*	59.6
HAQ-DI<0.5	51.6*	80.7
Missed workdays (n)	272.2± 338.9~	45.2 ±90.2

   Data are mean±SD unless indicated; Group2 vs group 1: * p<0.0001; ^**p=0.019;~p=0.006; °p=0.021

By logistic regression, anti-CCP antibodies, baseline ESR, age and moderate disease activity during the first year were significant independent risk factors of 3-year radiographic progression  Persistent moderate disease activity during the first year was the most significant risk factor for not achieving  clinical remission and for worst disability at 3 and 5 years

Conclusion:

Early RA patients with persistent moderate disease activity during the first year showed worst outcome than patients who achieved sustained clinical remission. Persistent moderate disease activity affects long-term structure, remission rate and functional and work disability. Such patients may benefit from an intensive therapeutic strategy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-the-long-term-outcome-for-rheumatoid-arthritis-patients-with-persistent-moderate-disease-activity-or-disease-remission-during-the-first-year-after-diagnosis-data-from-the-espoir-c/