To evaluate the long-term remission rates and relapse vulnerability in rheumatoid arthritis patients achieving clinical deep remission (CliDR) compared to those meeting less stringent DAS28-CRP remission criteria.
Key Findings:
63% of patients in the CliDR group maintained sustained remission at 5 years compared to 38% in the non-CliDR group.
Relapse occurred in 12 of 32 patients in the CliDR group versus 70 of 113 in the non-CliDR group.
Tapering treatment was associated with an 8.5-fold higher relapse hazard in non-CliDR patients, but the risk was significantly lower in the CliDR group.
Interpretation:
Achieving CliDR may provide better long-term remission outcomes and reduced relapse risk during treatment tapering compared to less stringent DAS28-CRP remission criteria.
Limitations:
Single-center design limits generalizability and may not reflect broader populations.
Modest sample size and limited statistical power may affect the reliability of findings.
Cohort highly selected with 97% anti-CCP positive and fewer than 10% on biologic DMARDs, limiting applicability to biologic-treated patients.
Conclusion:
Achieving clinical deep remission is associated with significantly higher sustained remission rates in rheumatoid arthritis patients, particularly relevant when considering medication tapering.
Nearly 40% of registry patients would have been excluded from phase 3 randomized controlled trials, with exclusion criteria distributed unevenly across drug classes.
Combined rheumatoid factor and anticitrullinated protein antibody status appeared to modify the association between baseline rheumatoid arthritis disease activity and subsequent cardiovascular events in an international observational cohort.
