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ACR 2016
11–16 NOVEMBER 2016 •
WASHINGTON DC, USA
The PracticeUpdate
Editorial Team bring
you our coverage of ACR
2016, featuring evidence
supporting earlier RA
diagnosis and treatment,
statins to lower mortality
risk in patients with
ankylosing spondylitis
and psoriatic athritis,
longer biologics use in
RA, and much more.
Remission rates in RA
have improved but earlier
diagnosis, treatment needed
Results of two retrospective reviews have revealed that, though
remission rates of patients with rheumatoid arthritis have improved
over the past few decades, time to diagnosis needs to be shortened
and early effective treatment begun.
J
ustine Vix, MD, of University Hospital
Poitiers, Poitiers, France, evaluated stable
remission in rheumatoid arthritis over 7
years of follow-up in “real life” conditions and
predictive factors of a positive outcome.
She explained that remission constitutes the
best achievable state in patients with rheumatoid
arthritis, and if remission is a goal, it need to be
maintained.
“I want to improve treatment,” Dr Vix commented,
“and optimise our patients’ best chance of a good
quality of life, avoid pain, joint damage, bone
erosion, deformation, and impaired functioning.”
Dr Vix and colleagues analysed clinical, biological,
immunogenetic, and radiographic records of
364 patients with active rheumatoid arthritis.
All fulfilled American College of Rheumatology
criteria and were seen in 2008. Mean patient age
was 62.9 years.
Patients were seen at least once a year in an
outpatient clinic or during hospitalisation. Data
were collected through 2015. Data were available
for 232 patients (75%) who were followed for
7 years.
Ninety-seven patients (31%) achieved American
College of Rheumatology/European League
Against Rheumatism remission, defined as
Disease Activity Score 28 <2.6, after 1 year.
A total of 133 patients (57%) achieved remission.
Mean activity per Disease Activity Score 28 was
3.44 after 1 year and decreased to 2.67 after 7
years of follow-up. Corticosteroids were stopped
in 38% of the cohort.
The remission rate (Disease Activity Score 28
<2.6) was 31% after 1 year and remained stable
in 76% of patients. Including patients not in
remission after 1 year, 48.6% achieved remission
during follow up and 17% were still in low disease
activity (Disease Activity Score 28 <3.2) in 2015.
Long-term remission was more frequent when
conventional disease-modifying antirheumatic
drugs were given with biological disease-
modifying antirheumatic drugs, especially anti-
tumour necrosis factor agents.
Dr Vix concluded that 76% of patients who
achieved remission after 1 year of treatment
maintained in long-term remission. Targeted
treatment with a combination of conventional and
biologic disease-modifying antirheumatic drugs
induced a higher rate of long-term remission.
Jon T. Einarsson, MD, of Lund University,
Lund, Sweden, investigated the impact of
changing treatment goals in national guidelines
on sustained remission, according to Disease
Activity Score 28 <2.6 on at least two consecutive
6-month periods.
He explained that emission has become a
treatment goal in rheumatoid arthritis, especially
since the introduction of biologic treatment
in 1999. The Swedish quality registry is a
nationwide registry for rheumatic diseases in
which all 64 rheumatology units in the country
participate.
All adult patients with rheumatoid arthritis included
in the registry from 1992–2013 and who were
followed through 2014 with at least three visits
were eligible (n=29,084). Median patient age was
59.6 years and 72% were female. Symptoms had
begun from 1934 through 2012. For parts of the
comparisons, only patients whose symptoms began
between 1999 and 2009 were studied.
© ACR/ARHP 2016 Annual Meeting • acrannualmeeting.orgPRACTICEUPDATE RHEUMATOLOGY & DERMATOLOGY
AMERICAN COLLEGE OF RHEUMATOLOGY 2016 ANNUAL MEETING
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