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Can treating rheumatoid arthritis with disease-modifying anti-rheumatic drugs at the window of opportunity with tight control strategy lead to long-term remission and medications free remission in real-world clinical practice? A cohort study

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Abstract

Objective

The aim of this retrospective study is to compare the results of starting rheumatoid arthritis (RA) treatment with tight control strategy in the window of opportunity and later phases of the disease in real-world clinical practice.

Methods

In this cohort, 609 RA patients were divided into three groups: (i) very early treatment (VET): ≤ 3 months; (ii) early treatment (ET): 3–12 months; and (iii) late treatment (LT) > 12 months after the onset of the disease. Four levels of remission were defined: (i) sustained remission on treatment, (ii) sustained glucocorticoids free remission, (iii) sustained disease-modifying anti-rheumatic drugs (DMARDs) free remission, and (iv) long-term remission. Outcome was assessed based on the number of patients in sustained or long-term remission and patients with poor joint outcome and systemic involvement.

Results

There were no significant differences in the remission rate between the groups. Time to sustained remission in VET group was shorter than ET and LT groups. There were no significant differences in the rate and duration of prednisolone discontinuation in the studied groups. DMARDs were discontinued in VET, ET, and LT groups in 8.7%, 10.2%, and 7% of the patients, respectively. Poor joint outcome occurred in 33.2%, 50.5%, and 59.4% of the patients in the VET, ET, and LT groups, respectively. Remission induction in the first year of the treatment was associated with long-term remission in the VET, ET, and LT groups.

Conclusions

Medications free remission in RA is rare, and although treatment with DMARDs within 3 months of the onset of the disease can prevent joint damage, it cannot lead to long-term remission and discontinuation of medications.

Key Points

• Medications free remission in rheumatoid arthritis is rare.

• Treatment with DMARDs within 3 months of the onset of the disease can prevent joint damage, but it cannot lead to long-term remission and discontinuation of medications.

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Acknowledgements

The authors thank all the patients for participating in this study.

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Authors and Affiliations

  1. Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Sanaz Ebrahimian, Amin Salami, Aida Malek Mahdavi, Alireza Khabbazi & Mehrzad Hajialilo

  2. Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran

    Kamal Esalatmanesh

Authors
  1. Sanaz Ebrahimian
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  2. Amin Salami
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  3. Aida Malek Mahdavi
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  4. Kamal Esalatmanesh
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  5. Alireza Khabbazi
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  6. Mehrzad Hajialilo
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Contributions

AS, AKH, and AMM designed the study; SE, AS, KE, AKH, and MH were involved in the data acquisition and/or management; AKH and AMM analyzed the data and critically interpreted the results; SE, AMM, and AKH were involved in drafting the manuscript. All authors revised the manuscript critically for important intellectual content and approved the final manuscript.

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Correspondence to Alireza Khabbazi.

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Ebrahimian, S., Salami, A., Malek Mahdavi, A. et al. Can treating rheumatoid arthritis with disease-modifying anti-rheumatic drugs at the window of opportunity with tight control strategy lead to long-term remission and medications free remission in real-world clinical practice? A cohort study . Clin Rheumatol 40, 4485–4491 (2021). https://doi.org/10.1007/s10067-021-05831-3

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  • DOI: https://doi.org/10.1007/s10067-021-05831-3

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