Comparable long-term outcomes between DAS28-ESR remission criteria and ACR/EULAR definitions in patients with established rheumatoid arthritis

• Published in: Clinical rheumatology Vol. 40; no. 7; pp. 2665 - 2672
• Main Authors: Ramírez, Julio, Inciarte-Mundo, José, Cuervo, Andrea, Celis, Raquel, Ruiz-Esquide, Virginia, Castellanos-Moreira, Raul, Ponce, Andrés, Gómez-Puerta, José A., Sanmartí, Raimon, Cañete, Juan D.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2021; Springer Nature B.V
• Subjects: Angiogenesis; Boolean; Inflammation; Interleukin 18; Medicine; Medicine & Public Health; Original Article; Patients; Remission; Remission (Medicine); Rheumatoid arthritis; Rheumatology; Serum levels; Ultrasound; Radiography; Biomarkers; Remission; Rheumatoid arthritis; Ultrasonography
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-021-05603-z

Objective To compare long-term clinical, immunological, and radiographic outcomes between five sets of remission criteria (four clinical and one ultrasound (US)-based) in a cohort of RA patients in a clinical care setting. Methods RA patients in remission (DAS28-ESR <2.6) were selected. Hand US assessments were made, and serum levels of inflammation/angiogenesis biomarkers were determined at baseline. Changes in baseline treatment and radiographic progression, defined as the variation in the modified Sharp van der Heijde score (mSHS) at 5 years, were analyzed. Five concepts were used to define remission: DAS28-ESR<2.6, SDAI<3.3, CDAI<2.8, Boolean criteria and Power Doppler score (PD)=0. Results Eighty-seven patients with DAS28-ESR<2.6 were included. One-third fulfilled SDAI (33.3%), CDAI (31%), and Boolean (35.6%) remission criteria, and 25.3% had no PD signal in the US evaluation. 26 patients (29.9%) changed therapy, ranging from 13.6% (PD remission) to 33.3% (CDAI remission) ( p =0.11). Serum levels of ANG ( p =0.015) and TNFa ( p =0.025) were significantly lower in patients with Boolean remission, whereas IL-18 levels were significantly lower in those with PD remission ( p =0.049). Patients without PD in the US assessment had significantly-lower mSHS erosion progression ( p =0.014) at 5 years. Conclusions Patients with established RA in DAS28-ESR remission had comparable clinical and radiographic outcomes in SDAI, CDAI, and Boolean definitions in a clinical care setting. US remission remained the closest to structural damage abrogation. Key Points • This study provides real world data on long-term outcomes of five clinical and imaging remission criteria in rheumatoid arthritis. • DAS28-ESR remission criteria had comparable radiographic progression and clinical prognosis than more stringent criteria in clinical practice. • US-based remission was closest to structural damage abolishment.