Getting RA into Remission Saves Lives

Early remission and sustained remission are associated with improved survival in patients with inflammatory polyarthritis, according to findings from the Norfolk Arthritis Register presented by Dr. Carlo Alberto Scirè at the annual European Congress of Rheumatology.

The findings provide further evidence of the importance of targeting remission, Dr. Scirè said in an interview.

"Several previous studies have demonstrated the influence of clinical remission in terms of reduction of joint damage and development of functional disability in patients with inflammatory polyarthritis, including rheumatoid arthritis. Given that rheumatoid arthritis also associates with increased mortality, we aimed to explore the relationship between clinical remission and mortality," said Dr. Scirè of the epidemiology unit of the Italian Society for Rheumatology, Milan, who is also currently a visiting scholar at the arthritis epidemiology unit of Manchester (England) University.

The Norfolk Arthritis Register, a primary care–based inception cohort of patients with inflammatory polyarthritis, provides a unique source of data with which to explore this relationship, he noted.

For the study, Dr. Scirè and his coinvestigators analyzed data from the more than 1,600 patients who were recruited in 1990-1994 and 2000-2004 and were followed for a median of 10 years. The investigators used three definitions of remission that varied in their strictness. More than a third of the patients met at least the most liberal definition of remission criteria at least once within the first 3 years. The strictest definition of remission allowed for the patient to have not a single swollen or tender joint in a 51 joint count exam. The least stringent allowed for a single swollen or tender joint in a 28-joint count exam, Dr. Scirè explained.

After the investigators adjusted for demographics, baseline disease activity, baseline disease severity, and cumulative treatment variables, 20% more of these patients survived compared with those who did not achieve remission within the first 3 years of follow-up.

The number of times patients achieved remission was also associated with a significant decrease in the risk of all-cause mortality, with a 10% decrease in risk per each additional time they achieved remission.

The greatest reduction in mortality risk was seen in those who achieved remission (as defined by the strictest standard) at 1 year after the first assessment, compared with those who did not achieve remission during the first 3 years. No similar association was found for patients who achieved remission after the first year, Dr. Scirè noted.

Registry patients included in the study were consecutive patients with early inflammatory polyarthritis. They were assessed at baseline through the 51 tender and swollen joint count, the Health Assessment Questionnaire, and blood testing. The joint counts were also assessed at the 1-, 2-, and 3-year follow-up.

Remission for this study was defined as the absence of clinically detectable joint inflammation.

"This study provides evidence of an association between the achievement of the absence of clinically detectable joint inflammation [used as an indicator of clinical remission] and decrease [in] mortality, supporting the relevance of targeting remission when treating rheumatoid arthritis in clinical practice," Dr. Scirè said.

Patients who met the strictest definition of remission seem to lengthen their survival by 2-3 years, according to Dr. Scirè. An audience member noted that the diagnosis of rheumatoid arthritis shortens life by about 7 years, so meeting a strict definition of remission within the first year after diagnosis comes close to halving that increased mortality burden.

Early remission and sustained remission are associated with improved survival in patients with inflammatory polyarthritis, according to findings from the Norfolk Arthritis Register presented by Dr. Carlo Alberto Scirè at the annual European Congress of Rheumatology.

The findings provide further evidence of the importance of targeting remission, Dr. Scirè said in an interview.

"Several previous studies have demonstrated the influence of clinical remission in terms of reduction of joint damage and development of functional disability in patients with inflammatory polyarthritis, including rheumatoid arthritis. Given that rheumatoid arthritis also associates with increased mortality, we aimed to explore the relationship between clinical remission and mortality," said Dr. Scirè of the epidemiology unit of the Italian Society for Rheumatology, Milan, who is also currently a visiting scholar at the arthritis epidemiology unit of Manchester (England) University.

The Norfolk Arthritis Register, a primary care–based inception cohort of patients with inflammatory polyarthritis, provides a unique source of data with which to explore this relationship, he noted.

For the study, Dr. Scirè and his coinvestigators analyzed data from the more than 1,600 patients who were recruited in 1990-1994 and 2000-2004 and were followed for a median of 10 years. The investigators used three definitions of remission that varied in their strictness. More than a third of the patients met at least the most liberal definition of remission criteria at least once within the first 3 years. The strictest definition of remission allowed for the patient to have not a single swollen or tender joint in a 51 joint count exam. The least stringent allowed for a single swollen or tender joint in a 28-joint count exam, Dr. Scirè explained.

After the investigators adjusted for demographics, baseline disease activity, baseline disease severity, and cumulative treatment variables, 20% more of these patients survived compared with those who did not achieve remission within the first 3 years of follow-up.

The number of times patients achieved remission was also associated with a significant decrease in the risk of all-cause mortality, with a 10% decrease in risk per each additional time they achieved remission.

The greatest reduction in mortality risk was seen in those who achieved remission (as defined by the strictest standard) at 1 year after the first assessment, compared with those who did not achieve remission during the first 3 years. No similar association was found for patients who achieved remission after the first year, Dr. Scirè noted.

Registry patients included in the study were consecutive patients with early inflammatory polyarthritis. They were assessed at baseline through the 51 tender and swollen joint count, the Health Assessment Questionnaire, and blood testing. The joint counts were also assessed at the 1-, 2-, and 3-year follow-up.

Remission for this study was defined as the absence of clinically detectable joint inflammation.

"This study provides evidence of an association between the achievement of the absence of clinically detectable joint inflammation [used as an indicator of clinical remission] and decrease [in] mortality, supporting the relevance of targeting remission when treating rheumatoid arthritis in clinical practice," Dr. Scirè said.

Patients who met the strictest definition of remission seem to lengthen their survival by 2-3 years, according to Dr. Scirè. An audience member noted that the diagnosis of rheumatoid arthritis shortens life by about 7 years, so meeting a strict definition of remission within the first year after diagnosis comes close to halving that increased mortality burden.

Early remission and sustained remission are associated with improved survival in patients with inflammatory polyarthritis, according to findings from the Norfolk Arthritis Register presented by Dr. Carlo Alberto Scirè at the annual European Congress of Rheumatology.

The findings provide further evidence of the importance of targeting remission, Dr. Scirè said in an interview.

"Several previous studies have demonstrated the influence of clinical remission in terms of reduction of joint damage and development of functional disability in patients with inflammatory polyarthritis, including rheumatoid arthritis. Given that rheumatoid arthritis also associates with increased mortality, we aimed to explore the relationship between clinical remission and mortality," said Dr. Scirè of the epidemiology unit of the Italian Society for Rheumatology, Milan, who is also currently a visiting scholar at the arthritis epidemiology unit of Manchester (England) University.

The Norfolk Arthritis Register, a primary care–based inception cohort of patients with inflammatory polyarthritis, provides a unique source of data with which to explore this relationship, he noted.

For the study, Dr. Scirè and his coinvestigators analyzed data from the more than 1,600 patients who were recruited in 1990-1994 and 2000-2004 and were followed for a median of 10 years. The investigators used three definitions of remission that varied in their strictness. More than a third of the patients met at least the most liberal definition of remission criteria at least once within the first 3 years. The strictest definition of remission allowed for the patient to have not a single swollen or tender joint in a 51 joint count exam. The least stringent allowed for a single swollen or tender joint in a 28-joint count exam, Dr. Scirè explained.

After the investigators adjusted for demographics, baseline disease activity, baseline disease severity, and cumulative treatment variables, 20% more of these patients survived compared with those who did not achieve remission within the first 3 years of follow-up.

The number of times patients achieved remission was also associated with a significant decrease in the risk of all-cause mortality, with a 10% decrease in risk per each additional time they achieved remission.

The greatest reduction in mortality risk was seen in those who achieved remission (as defined by the strictest standard) at 1 year after the first assessment, compared with those who did not achieve remission during the first 3 years. No similar association was found for patients who achieved remission after the first year, Dr. Scirè noted.

Registry patients included in the study were consecutive patients with early inflammatory polyarthritis. They were assessed at baseline through the 51 tender and swollen joint count, the Health Assessment Questionnaire, and blood testing. The joint counts were also assessed at the 1-, 2-, and 3-year follow-up.

Remission for this study was defined as the absence of clinically detectable joint inflammation.

"This study provides evidence of an association between the achievement of the absence of clinically detectable joint inflammation [used as an indicator of clinical remission] and decrease [in] mortality, supporting the relevance of targeting remission when treating rheumatoid arthritis in clinical practice," Dr. Scirè said.

Patients who met the strictest definition of remission seem to lengthen their survival by 2-3 years, according to Dr. Scirè. An audience member noted that the diagnosis of rheumatoid arthritis shortens life by about 7 years, so meeting a strict definition of remission within the first year after diagnosis comes close to halving that increased mortality burden.