Rheumatology International

, Volume 38, Issue 8, pp 1465–1470 | Cite as

Identifying markers of sustained remission in rheumatoid arthritis patients on long-term tapered biological disease-modifying antirheumatic drugs

  • Lara ValorEmail author
  • Jesús Garrido
  • Lina Martínez-Estupiñán
  • Diana Hernández-Flórez
  • Iustina Janta
  • Francisco Javier López-Longo
  • Indalecio Monteagudo
  • Carlos M. González
  • Esperanza Naredo


To identify features associated with long-term persistent remission in rheumatoid arthritis (RA) patients on tapered biological disease-modifying antirheumatic drugs (bDMARD) (tap-bDMARD) therapy. We carried out a 40-month (m) extension follow-up study of 77 RA patients from a previous 12 m tap-bDMARD study. Disease activity was assessed at baseline and every 3 months. Doppler US investigation of 42 joints for the presence and grade (0–3) of B-mode synovial hypertrophy (SH) and synovial power Doppler signal (i.e., Doppler synovitis) was performed before starting the tap-bDMARD strategy by a rheumatologist blinded to clinical and laboratory data. At the 40 m mark, 44 (57.1%) patients failed the tap-bDMARD strategy, while 33 (42.9%) succeeded. Patients who presented a failed tap-bDMARD had significantly longer disease duration, a longer time from symptom onset to synthetic (s) DMARD start, longer duration of sDMARD treatment, a greater number of sDMARDs, and a higher baseline DAS28 and SDAI than patients with successful tap-bDMARD at 40 months. In logistic regression analysis, the presence of baseline Doppler synovitis, a DAS28 ≥ 2.2, and the presence of rheumatoid factor were identified as predictors of tap-bDMARD failure at 40 m. In those patients who succeed tap-bDMARD at 12 m, a smoking habit was significantly more frequently found in tap-bDMARD failures at 40 m. Our results showed that DAS28 and the presence of Doppler synovitis, RF and a smoking habit predicted long-term tap-bDMARD failure.


Rheumatoid arthritis Biologic therapy Tapering Musculoskeletal ultrasound 



The authors would like to thank all patients who kindly consented to participate in this study and the Spanish Society of Rheumatology for their support throughout the manuscript preparation process.

Author contributions

E.N., L.V., J.G.: study design. E.N, L.V., I.J. I.M., F.J.L.-L., D.H-F., C.G.: acquisition of data. E.N., L.V., L.M-E., J.G.: analysis and interpretation of data. E.N., L.V., L.M-E., J.G.: manuscript preparation.


The authors received no specific funding for this work.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Lara Valor
    • 1
    Email author
  • Jesús Garrido
    • 2
  • Lina Martínez-Estupiñán
    • 1
  • Diana Hernández-Flórez
    • 1
  • Iustina Janta
    • 1
  • Francisco Javier López-Longo
    • 1
  • Indalecio Monteagudo
    • 1
  • Carlos M. González
    • 1
  • Esperanza Naredo
    • 3
  1. 1.Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of MedicineUniversidad ComplutenseMadridSpain
  2. 2.Department of Social Psychology and MethodologyUniversidad Autónoma de MadridMadridSpain
  3. 3.Department of Rheumatology, Joint and Bone Research UnitHospital Universitario Fundación Jiménez DíazMadridSpain

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