Background/Purpose: Rapid time-to-remission has been associated with sustained remission in established rheumatoid arthritis (RA)¹. However, the prevalence and predictive factors of sustained remission in early RA is poorly understood, especially in the context of stringent remission definitions.

Methods: We used data from the Canadian early ArThritis CoHort (CATCH) and included patients with probable or confirmed RA. Remission was defined according to the ACR/EULAR clinical practice definition (TJC ≤1, SJC ≤1 and patient global ≤ 1) and SDAI ≤ 3.3. Patients in CATCH are seen q3months in year 1 and q6montly thereafter. Sustainability was defined as ≥6 months or 2 consecutive visits with ACR/EULAR or SDAI remission.Predictors for sustained remission were identified by logistic regression analysis, adjusted for clinical confounders.

Results: 1244 patients were included. 83% were Caucasian and 73% were female, with mean age (SD) of 53.6 (14.6) years, and mean symptom duration (SD) of 6.0 (3.1) months.  Initial treatment within the 1st 3 months included: methotrexate monotherapy in 392 (32%), combination DMARDs in 548 (44%), and biologics in 27 (2%).  522 (42%) achieved ACR/EULAR and 484/1205 (40%) SDAI remission with a median time-to-remission of 23.9 months for each. In those ever achieving sustained remission, 309 (59.2%) and 273 (56.4%) did so for sustained ACR/EULAR and SDAI remission. Factors associated with increased probability of sustained remission were younger age, low baseline pain scores and earlier time-to-first remission (Table). Baseline RF, CCP, patient global, smoking status, symptom duration, DAS28, HAQ, fatigue, AM stiffness and erosions had no effect on sustained remission. No initial treatment strategy predicted sustained remission, nor did biologic use within the first 6 months (8%).

Table. Multivariate analysis of baseline predictors and time-to-remission as a predictor for sustained ACR/EULAR or SDAI remission.

Characteristic	ACR/EULAR Clinical Practice Remission		SDAI Remission
	OR (95% CI)	p-value	OR (95% CI)	p-value
Age*, years	0.98 (0.96, 0.99)	0.002	0.98 (0.96, 0.99)	0.006
Female sex	0.62 (0.39, 0.99)	0.04	0.78 (0.48, 1.26)	0.31
Pain score*	0.99 (0.98, 0.99)	0.04	0.98 (0.98, 0.99)	0.03
Methotrexate monotherapy	0.95 (0.55, 1.66)	0.86	0.68 (0.37, 1.23)	0.20
Combination DMARD therapy	1.49 (0.88, 2.51)	0.14	1.42 (0.80, 2.51)	0.23
Biologic DMARD within 6 months	1.68 (0.75, 3.74)	0.21	0.85 (0.39, 1.85)	0.69
Time-to-remission	0.997 (0.996, 0.998)	<0.0001	0.997 (0.996, 0.998)	<0.0001

* Treated as continuous variables

Conclusion: Even when stringent definitions of remission are considered, sustained remission is possible within two years for ERA patients initially treated with conventional DMARDs. The time to reach sustained remission may be falsely long as after year 1, data is collected only every 6 months. Gender influenced the chance of remission only in ACR/EULAR remission. Demographic characteristics and pain are important predictors of sustained remission.  Shorter time-to-remission is also related to sustainability and supports striving for early remission in patients with ERA. The optimal treatment approach for sustained remission in this cohort could not be determined.

Reference: Schipper LG et al. Time to achieve remission determines time to be in remission. Arthritis Res Ther. 2010;12(3):R97.

---

« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-sustained-clinical-remissionin-early-rheumatoid-arthritis-results-from-the-canadian-early-arthritis-cohort/