Background/Purpose

Remission has become a more achievable goal in rheumatoid arthritis (RA). Several criteria for remission are available in RA, including one based on RAPID3 (routine assessment of patient index data 3) with <1 swollen joint (RAPID3≤3+SJ≤1), which identifies remission similarly to Boolean and SDAI criteria [1]. It would be of value to know if any remission criteria predict radiographic progression more effectively than others.  We analyzed radiographic progression according to remission status in the ESPOIR French early arthritis cohort, in which only 18.3% of patients received a biological DMARD over a 5 year follow-up as part of their routine care [2].

Methods

Radiographic progression over 1 year was analyzed in the ESPOIR cohort, which includes early arthritis patients who received routine care. Remission was assessed 12 months after baseline, according to 6 different criteria: ACR Boolean criteria; simplified disease activity index (SDAI) ≤3.3; clinical disease activity index (CDAI) ≤2.8; disease activity score (DAS28) <2.6; RAPID3 ≤3; and RAPID3≤3+SJ≤1.The numbers of patients whose radiographic progression according to the Sharp van der Heijde score was ≥5 -the smallest detectable difference (SDD) [3], ≥10 or ≥20 units at 24 months (12 months after the remission assessment) were analyzed, according to whether patients had been in remission 12 months earlier for each of the 6 criteria, using chi-square tests for statistical significance.

Results

Radiographic progression ≥5 units (SDD) was seen in 10.1%-11.8% of patients in remission compared to 13.0%-13.8% of patients not in remission; differences were not statistically significant (p>0.3) (Table). Progression ≥10 units was seen in 1.4-4.3% of patients in remission versus 6.5-7.6% of those not in remission, a 2-fold difference; only differences by DAS28 and RAPID3≤3+SJ≤1 were statistically significant (p<0.05). Progression ≥20 units was seen in 0.1-1.1% of those in remission versus 2.6-3.1% of those not in remission, a 3-fold difference, statistically significant for SDAI, CDAI, DAS28 and RAPID3≤3+SJ≤1.  A sub analysis including 179 patients with radiographic damage at baseline and rheumatoid factor positivity was performed, with similar results.  

Remission Criteria	Remission vs Non remission	Radiographic progression (%) over 1 year according to remission status
		≥ 5 units		≥ 10 units		≥ 20 units
		Remission	No Remission	Remission	No Remission	Remission	No Remission
Boolean	140 vs 492	10.9%	13.0%	3.6%	6.5%	0%	2.6%
SDAI ≤ 3.3	135 vs 467	10.4%	13.3%	3.0%	6.9%	0%	2.8%*
CDAI ≤ 2.8	135 vs 467	10.4%	13.3%	3.0%	6.9%	0%	2.8%*
DAS28 ≤ 2.6	247 vs 355	10.9%	13.8%	3.6%	7.6%*	0.8%	3.1%*
RAPID3 ≤ 3	187 vs 415	11.8%	13.0%	4.3%	6.8%	1.1%	2.7%
RAPID3≤3+SJ≤1	139 vs 463	10.1%	13.4%	1.4%	7.3%*	0%	2.8%*

*p ≤ 0.05

Conclusion

Very little radiographic progression was seen in patients receiving routine care in recent years although only 18.3% of patients received a biological agent. Differences between patients in remission or non become apparent when applying higher cut-off points to define radiographic progression.

References: 1. J Rheumatol 2013;40:386-93. 2. J Rheumatol 2013;40:1650-7 3.Arthritis Rheum 2002;46:913–20

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/minimal-radiographic-progression-in-ra-patients-receiving-routine-care-in-the-espoir-early-arthritis-cohort-similar-prognosis-according-to-6-different-remission-criteria/