Sustained remission reduces the risk for radiographic progression in patients with rheumatoid arthritis (RA), say researchers who found that both severity of disease activity and length of remission influence the likelihood of future joint damage.
Daniel Aletaha (Medical University of Vienna, Austria) and co-workers investigated whether disease activity has a latent impact on radiographic progression in 794 early RA patients participating in a 2-year clinical trial of disease-modifying anti-rheumatic drug regimes.
Fifteen per cent of patients achieved remission in the second year of the trial, defined as a Simplified Disease Activity Index (SDAI) of 3.3 or less. Their modified total Sharp scores for radiographic progression of joint damage were compared with scores for patients whose disease was in remission for 3, 6, or 9 months of the first year of the trial.
As reported in the journal Arthritis and Rheumatism, patients who achieved remission in the second year had significantly different Sharp scores from those with an additional 3, 6, and 9 months of remission (1.00 vs 1.11, 0.20, and -0.32, respectively).
Of note, the average SDAI score between month 12 and 24 in the study was comparable between patients who achieved 3, 6, and 9 months of remission in the first year of the study (1.8, 1.5, and 1.4, respectively).
“These data indicate that carry-over effects governed the differences in the progression rates among patients whose disease was in remission,” Aletaha et al say.
They therefore conclude: “Sustained remission is the ultimate goal to prevent the occurrence of joint destruction and, consequently, the accrual of irreversible disability in RA.
“Moreover, in the process of therapeutic decision-making, the assessment of radiographic progression of joint damage will have to account for these observations regarding the latency of radiographic manifestations in patients with RA.”