Recent years have witnessed significant advancements in RA management and achieving remission or low disease activity (LDA) has emerged as a treatment goal. According to a study published in Arthritis Research and Therapy, the 10-year structural and functional prognosis of patients with early RA was compared between those in sustained remission and those in sustained LDA. The researchers have found that RA patients who are in sustained Simple Disease Activity Index (SDAI) remission have better long-term structural and functional outcomes as compared to those in sustained LDA.
The study included patients who had experienced synovitis of small joints lasting for >6 weeks but <6 months on at least two occasions, who had not previously received any disease-modifying antirheumatic drugs (DMARD), and who were suspected of having RA. These patients were prospectively followed every 6 months for the first 2 years and then annually for up to 10 years. Demographic, clinical, and biological characteristics were assessed at each visit, and X-rays were performed. Patients who met the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria during the cohort follow-up were selected for this study (n=646).
Dr. Witrand and colleagues found a significant difference in the 10-year structural progression and 10-year Health Assessment Questionnaire Disability Index (HAQ-DI) between patients in SDAI-sustained remission and those in SDAI-sustained LDA. However, when the simple disease activity index (DAS28-ESR) was employed to classify the patients, no significant difference in the 10-year structural progression was identified between patients in sustained remission and those in sustained LDA. Witrand et al. stated that achieving remission has a significant impact on long-term outcomes compared to moderate or high disease activity. This study confirmed that patients who were able to sustain SDAI or DAS28-ESR remission for 10 years had less structural progression and functional impairment at the end of the study period.
In line with the current findings, Hirano et al. in 2017 concluded the validity of SDAI remission in predicting subsequent functional and structural outcomes in real-world clinical settings using the treat-to-target strategy. The study has noted a significant association between HAQ-DI and SDAI remission at week 24.
This study found a clear link between long-term structural and functional outcomes and sustained remission. The study findings underscore the significance of prioritizing sustained SDAI remission as a primary objective when managing RA patients.
- Ruyssen-Witrand A, Guernec G, Dupont J, Lapuyade D, Lioté F, Vittecoq O, Degboé Y, et al. Ten-year radiographic and functional outcomes in rheumatoid arthritis patients in remission compared to patients in low disease activity. Arthritis Res Ther. 2023 Oct 20;25(1):207
- Hirano F, Yokoyama W, Yamazaki H, Amano K, Kawakami A, Hayashi T, et al. Achieving simplified disease activity index remission in patients with active rheumatoid arthritis is associated with subsequent good functional and structural outcomes in a real-world clinical setting under a treat-to-target strategy. Mod Rheumatol. 2017 Sep;27(5):811-819