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

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Abstract

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.

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Acknowledgments

We thank Ana Vázquez and Anna Espinal from Servei d´Estadística Aplicada, Universitat Autonoma de Barcelona, for their advice on the statistical analysis. We thank David Buss for editorial assistance.

Funding

This work was supported by Instituto de Salud Carlos III (FIS 11/01890 (JDC) and RIER RD12/0009). Co-financed by FEDER, European Union, “Una manera de hacer Europa”.

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Authors and Affiliations

  1. Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain

    Julio Ramírez, José Inciarte-Mundo, Andrea Cuervo, Raquel Celis, Virginia Ruiz-Esquide, Raul Castellanos-Moreira, Andrés Ponce, José A. Gómez-Puerta, Raimon Sanmartí & Juan D. Cañete

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  1. Julio Ramírez
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Contributions

JR and JDC had full access to all the study data and take responsibility for the integrity of the data and the accuracy of data analysis. JR, JDC, and RS were responsible for the study design. JR, JIM, VRE, RCM, AP, RC, AC, and JGP performed data acquisition, analysis, interpretation, and final approval of the manuscript. Manuscript preparation was by JR, JDC, and RS. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Julio Ramírez.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Hospital Clinic of Barcelona Research Ethics Committee (HCB-2017-0562). Signed informed consent was obtained from all patients.

Disclosures

None.

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Pre-print version

We state that parts of this manuscript have been published on a preprint server DOI:https://doi.org/10.21203/rs.3.rs-34234/v1.

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Ramírez, J., Inciarte-Mundo, J., Cuervo, A. et al. Comparable long-term outcomes between DAS28-ESR remission criteria and ACR/EULAR definitions in patients with established rheumatoid arthritis. Clin Rheumatol 40, 2665–2672 (2021). https://doi.org/10.1007/s10067-021-05603-z

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  • DOI: https://doi.org/10.1007/s10067-021-05603-z

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