Original articlePrevalence and concordance of early and sustained remission assessed by various validated indices in the early arthritis “ESPOIR” cohort
Introduction
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that is characterized by joint inflammation leading to joint destruction. This causes decreased functional capacity, work disability, and reduced quality of life [1]. Studies evaluating tight control and treat-to-target strategies advocate that remission should be reached as soon as possible and should ideally be maintained during the course of the disease [2], [3]. Since a cure has not yet been established for rheumatoid arthritis (RA), the best achievable state in patients with RA is remission. However, the best way to define remission is still under debate. Categories of high, moderate, and low disease activity as well as remission have been identified for the most commonly used indices: the disease activity score using 28 joint counts (DAS28) [4], and Simplified Disease Activity Index (SDAI) [5]. The American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) recently proposed new definitions of remission in RA for clinical trials, which could also be used as the primary outcome of clinical trials and real life practice [6], [7]. Testing these new remission criteria in RA cohorts was encouraged to determine their practicality for daily use [6]. Recently, a validation of these criteria using the ESPOIR study showed that patients in ACR/EULAR remission in ESPOIR had a high rate of later radiographic and functional stability, and suggests that these definitions of remission are valid in clinical practice settings [8].
Better knowledge about prevalence and prognostic factors for remission might improve patient care according to their individual profile. Only a few studies have examined sustained remission in usual clinical settings [9], [10], [11]. In the literature, definitions of sustained remission in RA vary considerably in both measurement and duration, and whether discontinuation of antirheumatic treatment is a prerequisite remains also debated.
The aim of this study was to assess the prevalence of remission during the initial follow-up of a cohort of patients with early inflammatory arthritis, to evaluate the concordance across different criteria sets in defining this state, and to look for predictive factors for early and sustained remission in RA patients.
Section snippets
Source data
The ESPOIR cohort is a nationwide prospective cohort study of adults in France conducted under the auspices of the French Society of Rheumatology [12]. The study was approved by the Institutional Review Board of the Montpellier University Hospital, which was the coordinating center. Prior to inclusion, written informed consent was obtained from each participant.
This cohort has included 813 patients with early arthritis between December 2002 and March 2005. Forteen participating investigational
Demographic, clinical and biological characteristics of the 3 groups of patients
Table 1 shows the baseline characteristics of the patients. The mean age was 48.5 ± 12.2 years, 46.5 ± 13.7, and 48.1 ± 12.6 for patients who were diagnosed as having RA after 1 year of follow-up, UA and the whole cohort, respectively. Among the RA patients, 371 (55,5%) had high disease activity at baseline (DAS28 > 5.1) vs. 392 (49.5%) of the whole cohort and 20 (16.4%) of the UA.
Remission rate at 6 months follow-up visit according to the 3 definitions in the 3 groups of the patients
Early remissions in the RA patients, UA and the whole cohort were observed in respectively 29.2%, 51.4% and 32.7% of patients
Discussion
Early remission rates in the RA/UA/ESPOIR groups were observed in one third approximately of RA patients by DAS28; and in one fifth of patients by SDAI and ACR/EULAR criteria. Occurrence of remission at all time points was lowest for the ACR/EULAR clinical trial criteria, making it the most stringent remission definition. Baseline low disease activity, pre-menopausal status and younger age predicted the clinical remission.
Our results echo the work of others, demonstrating higher response rates
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
Acknowledgements
The authors wish to thank all investigators who recruited and followed the patients (F. Berenbaum, Paris-Saint-Antoine; M.C. Boissier, Paris-Bobigny; A. Cantagrel, Toulouse; H. Cholvy, Montpellier; M. Dougados, Paris-Cochin; P. Fardelone and P. Boumier, Amiens; B. Fautrel, Paris-La Pitié; R.M. Flipo, Lille; P. Goupille, Tours; F. Liote, Paris-Lariboisière; X. Le Loet and O. Vittecoq, Rouen; X. Mariette, Paris-Bicêtre; O. Meyer, Paris-Bichat; A. Saraux, Brest; T. Schaeverbeke, Bordeaux;
References (31)
- et al.
ESPOIR cohort: a ten-year follow-up of early arthritis in France: methodology and baseline characteristics of the 813 included patients
Joint Bone Spine
(2007) - et al.
Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis
Lancet
(1989) - et al.
Methods used to assess remission and low disease activity in rheumatoid arthritis
Autoimmun Rev
(2010) Long-term outcomes of rheumatoid arthritis
Current Opin Rheumatol
(2009)- et al.
Evidence for treating rheumatoid arthritis to target: results of a systematic literature search
Ann Rheum Dis
(2010) - et al.
Treating rheumatoid arthritis to target: recommendations of an international task force
Ann Rheum Dis
(2010) - et al.
Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis
Arthritis Rheum
(1995) - et al.
The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis
Clin Exp Rheumatol
(2005) - et al.
American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials
Arthritis Rheum
(2011) - et al.
Remission of rheumatoid arthritis in clinical practice: application of the American College of Rheumatology/European League Against Rheumatism 2011 remission criteria
Arthritis Rheum
(2011)
Validation of ACR/EULAR definition of remission in rheumatoid arthritis from RA practice: the ESPOIR cohort
Arthritis Res Ther
Sustained clinical remission in rheumatoid arthritis: prevalence and prognostic factors in an inception cohort of patients treated with conventional DMARDS
Rheumatology
Long-term sustained remission in a cohort study of patients with rheumatoid arthritis: choice of remission criteria
BMJ Open
Sustained rheumatoid arthritis remission is uncommon in clinical practice
Arthritis Res Ther
Favorable effect of very early disease-modifying antirheumatic drug treatment on radiographic progression in early inflammatory arthritis: data from the étude et suivi des polyarthrites indifférenciées récentes (study and follow-up of early undifferentiated polyarthritis)
Arthritis Rheum
Cited by (20)
Gut microbiota in pre-clinical rheumatoid arthritis: From pathogenesis to preventing progression
2023, Journal of AutoimmunityRate of remission among rheumatoid arthritis patients being treated by rheumatologists in routine practice
2020, Revue du Rhumatisme (Edition Francaise)Early lessons from the recent-onset rheumatoid arthritis cohort ESPOIR
2015, Joint Bone SpineCitation Excerpt :ESPOIR enabled the validation in the real-life setting of the ACR/EULAR criteria for RA remission developed based on therapeutic trials [15]. An ESPOIR study confirmed that the proportion of patients achieving an early and sustained remission in recent-onset RA varied according to the criterion used and was highest with the DAS28 [16]. A close correlation was demonstrated between the ACR/EULAR criteria and the Simplified Disease Activity Index (SDAI).
Que nous ont apporté les premières années dg€™études dg€™une cohorte de polyarthrites rhumatoïdes débutantes: la cohorte ESPOIR ?
2014, Revue du Rhumatisme (Edition Francaise)