Background/Purpose: The Swedish Society for Rheumatology guidelines recommend remission as treatment goal for patients with rheumatoid arthritis (RA). The Swedish quality registry (SRQ) is a nationwide registry for rheumatic diseases in which all 64 rheumatology units in the country participate. The aim of this study was to examine how many patients reach sustained remission (SR) (DAS28<2.6 or SDAI<3.3 or CDAI 2.8 or ACR remission on at least 2 consecutive occasions and for at least 6 months) during follow up and to compare patients with early RA (first visit within 6 months symptom duration) with patients with established RA.

Methods: All adult patients with RA (n=29084) included in SRQ between 1992 and 2013, with at least 3 registered visits were eligible for the present study.  72% were female. Mean age was 58.8 years. 6691(20.5%) fulfilled the criteria for early RA described above. ACR 1987 criteria were satisfied by 95% of patients and 73.2% were ACPA positive. Duration of remission was defined as time between first visit fulfilling the remission criteria and subsequent first visit with higher disease activity.

Results: 12193 (41.9%) patients reached DAS28 SR, and 22.2%, 21.3% and 17.5% of patients reached sustained CDAI, SDAI and ACR remission, respectively, at some time point during follow up. The point prevalence of DAS28 SR 12 months after symptom onset was 16.4%, and 6.5%, 6.0% and 4.6% for CDAI, SDAI and ACR SR, respectively, and peaked after 5 years (figure1). The prevalence of DAS28 SR one year from symptom onset was 21.3% and 9.8% for early RA and established RA, respectively, and the difference remained for at least 10 years (p<0.001). Figure1 shows the percentage of patients being in SR in relation to symptom duration in years according to different remission criteria and stratified into early and established RA. The median time from symptom onset to DAS28 SR was 3.9 years, of those that reach SR, 75% have done so within 12 years (Range 0-74 years).   Median time in DAS28 remission was 2.8 years (range 0.5-18.3), and 2.2 (0.5-17.1), 2.2 (0.5-17.1) and 2.1 (0.5-17.0) for CDAI, SDAI and ACR remission, respectively.

Conclusion: About 42% of patients with RA in Sweden reached DAS28 SR during the course of the disease, twice as many as those that reached SDAI, CDAI or ACR SR.  The prevalence of SR is higher among early RA patients. Median time in DAS28 SR was just under three years and lower in SDAI, CDAI and ACR remission. The findings underline the need for early intervention but also shows that there is room for further improvement of the treatment strategy. Figure1. The percentage of patients being in SR in relation to symptom duration in years according to different remission criteria and stratified into early and established RA.