Background/Purpose:

The ultimate goal of Disease Modifying Anti-Rheumatic Drugs (DMARDs) treatment in early rheumatoid arthritis (RA) is to achieve remission in order to prevent structural damage and long term disability according to EULAR’s recommendations. However, remission status is not always obtained and low disease activity (LDA) might be an alternative goal. Recently, an ACR/EULAR initiative recommended the use of Simple Disease Activity Score (SDAI) as a remission criterion. The aim is to assess whether obtaining SDAI remission status or LDA status at one year has a differential impact on Sharp van der Heijde Total Score (mTSS) and Health Assessment Questionnaire Disability Index (HAQ-DI) score at 3 years in early RA patients treated in routine practice.

Methods: Patients: 813 DMARD and corticosteroids-naïve patients with early arthritis were included in the ESPOIR cohort and were prospectively followed. Among them, 625 fulfilled the 2010 ACR/EULAR criteria for RA at baseline and had a SDAI score at one year. 496 of them had available radiographs at 3 years and 535 had available HAQ-DI score at 3 years. Data analyzed: Remission was defined by a SDAI ≤ 3.3; LDA by a 3.3 < SDAI score ≤ 11. Radiographs were centrally read by one rheumatologist and scored using the Sharp van der Heijde scoring method at the inclusion and 3 years. Analysis: comparison of mTSS and HAQ-DI scores at 3 years between patients in SDAI remission or LDA at one year using a t-test. A multivariate analysis using a linear mixed model was performed to assess the independent effect of patient SDAI status at one year on mTSS and HAQ-DI at 3 years, including age, gender, disease duration, clinical center, erosions at baseline, ACPA presence, smoking habits, DMARDs use, the delay of DMARD start, biologic agents use and glucocorticoid use as covariables. The comparison between remission and LDA in terms of mTSS and HAQ-DI score at 3 years was obtained from the multivariate model with contrasts method.

Results:

Of the 625 patients included in the study (age median=49 years [IQR:40-58], women: n=391 (79%), disease duration median=5 months [IQR:3-8] n=121 (19%) were in remission after one year and n=223 (36%) were in LDA. The mTSS mean score at 3 years was about 9.6 (SD: 9.2) in patients in remission at one year compared to 15.8 (SD:16.1) in patients with LDA (t-test: p=0.0005). The HAQ-DI mean score at 3 years was about 0.23 (SD: 0.42) in patients in remission at one year compared to 0.43 (SD:0.52) in patients with LDA (t-test: p=0.0005). After multivariate analysis, the remission status obtained after one year was independently associated with lower 3-year mTSS compared to LDA status (mean difference=-0;265, SD=0.094, p=0.005). After multivariate analysis, the remission status obtained after one year was not independently associated with HAQ-DI score at 3 years compared to LDA status (mean difference=-0;54, SD=0.59, p=0.4).

Conclusion: this study shows that aiming SDAI remission at one year leads to better radiographic and functional outcomes at 3 years compared to LDA in early RA patients treated in routine practice.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/aiming-simple-disease-activity-score-remission-at-one-year-leads-to-better-3-year-radiographic-and-functional-outcomes-than-aiming-low-disease-activity-in-early-rheumatoid-arthritis-patients/