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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.org

PRACTICEUPDATE RHEUMATOLOGY & DERMATOLOGY

AMERICAN COLLEGE OF RHEUMATOLOGY 2016 ANNUAL MEETING

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