Background/Purpose: Preventing functional loss is crucial to early RA (ERA) patients in order to maintain usual activities of daily living. However, whether achieving early and sustained remission could predict long-term functional status remain uncertain. The aim of this study is to ascertain whether early-sustained remission can prevent loss of functional ability in ERA patients.

Methods: ERA patients with symptom onset < 2 years were enrolled into the Clinical Rheumatology Systematic Treat-to-target in Asia Leadership (CRYSTAL) Project. All subjects satisfied the 2010 ACR classification criteria for RA. Clinical assessments were performed for every three months in the first year, then yearly until the sixth year. Disease Activity Score 28 (DAS-28) and Health Assessment Questionnaire Disability Index (HAQ-DI) were recorded each visit. Early-sustained remission is defined as achieving DAS28-CRP < 2.6 consecutively from month 6 to year 4. Substantial functional ability loss is defined as HAQ-DI >0.5 at year 4. Potential independent predictors including baseline characteristics and early-sustained remission at year 4 were determined using multivariate logistic regression analysis.

Results: One-hundred-and-thirteen patients (age: 52.8±12.0 years, female: 90/113 (80%)) who completed year 4 assessment were included. Significant improvement in disease activity is observed (DAS28-CRP: 4.42±1.29 at baseline vs 2.34±0.99 at year 4, p< 0.001). Majority of patients (103/113, 91.2%) were on conventional synthetic DMARDs and 8/113 (7.1%) on biologic DMARDs. 47/113 (42%) patients achieved early-sustained remission, with 5/47 (11%) achieving drug-free remission. Patients with early sustained remission had a milder disease at baseline (Table 1). At year 4, there were less patients with substantial functional loss in the early-sustained remission group (6/46 (13%) vs 25/66 (40%), p=0.003) (Figure 1).

Using multivariate logistic regression, early-sustained remission is a protective factor for substantial functional loss at year 4 (OR: 0.26, 95% CI: 0.09-0.77, p=0.015) after adjusting baseline variables. Whereas independent risk factors for functional loss include female gender and HAQ-DI at baseline (Table 2).

Conclusion: Long-term functional ability loss can be prevented in ERA patients who achieved early-sustained remission. Baseline HAQ-DI indicates a risk factor for substantial functional loss, therefore early disease control aiming for consistent remission is crucial.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-achieving-early-sustained-remission-on-preventing-long-term-functional-loss-in-patients-with-early-rheumatoid-arthritis/