Remission after conventional treatment for RA is attainable

Sustained disease-modifying antirheumatic drug (DMARD)-free remission occurs in about 10% of patients with rheumatoid arthritis (RA). It can be predicted by several clinical variables that are assessed routinely in outpatient clinics.

van der Woude and colleagues evaluated RA remission after conventional treatment in 454 patients from the Leiden Early Arthritis Clinic (EAC) and 895 patients in the British Early Rheumatoid Arthritis Study (ERAS). Patients reached study end point if they were taking no DMARDs, had no swollen joints, and were deemed by a rheumatologist to be in DMARD-free remission-all for at least 1 year.

Sustained DMARD-free remission was achieved by 15% of the EAC patients and 9.4% of the ERAS patients. Among all patients, the prevalence of remission increased for the first 7 years before stabilizing; the average time to remission was 43 months. Everyone in remission shared the following factors: RA started acutely and was managed quickly, radiographic joint damage was minimal, the patients lacked IgM rheumatoid factor and human leukocyte antigen shared epitope alleles, and they were nonsmokers. Independent predictors of DMARD-free remission were short symptom duration and the absence of autoantibodies.

The authors noted that additional studies are warranted to further elucidate the underlying mechanisms.