Remission Ups Survival in Inflammatory Polyarthritis

Kate Johnson

June 10, 2012

June 10, 2012 (Berlin, Germany) — Early and sustained remission in inflammatory polyarthritis is associated with significantly increased survival, if measured according to stringent remission criteria, research reported here at the European League Against Rheumatism (EULAR) Congress 2012 shows.

"Early remission is thought to prevent long-term detrimental outcomes such as joint damage and functional disability, but data on survival is scarce," said lead author Carlo Scirè, MD, from the Arthritis Research UK Epidemiology Unit, at University of Manchester in the United Kingdom (UK).

"This is very, very important data for rheumatologists who want to adhere to early intensive treatment of inflammatory polyarthritis and treating to target, and it is one of the first pieces of hard evidence that there may be benefit in doing so," commented Patrick Verschueren, MD, PhD, from Universitaire Ziekenhuizen Leuven, Belgium, and chair of the session.

The study included 1828 consecutive patients with early inflammatory polyarthritis from the Norfolk Arthritis Registry, a primary care–based inception cohort recruited between 1990 and 1994 (first cohort) and between 2000 and 2004 (second cohort).

Patients were a mean age of 55.7 years, 66.7% were female, and all were required to have 2 or more swollen joints for at least 4 weeks and at least 3 years of follow-up in the registry. All-cause death was tracked in the national UK death registry up until May 2011.

The study analyzed survival outcomes based on 3 different definitions of remission. The most stringent definition required the absence of clinically detectable joint involvement on an extensive joint count of 51 joints, said Dr. Scirè. A less stringent definition was the absence of clinically detectable joint involvement on a 28-joint count, and the least stringent definition was the involvement of no more than 1 joint on a 28-joint count.

In addition to presence or absence of remission, several other remission variables were included in the analysis, namely, time to remission and number of remissions, he said.

Using the most stringent definition of remission, the researchers found that 29.6% of patients achieved at least 1 remission within the 3-year follow-up period. For 17% it was a single remission; 7.5% had 2 and 4.9% had 3 remissions.

Twelve percent reached remission within the first year, 9.2% by the second, and 7.8% by the third.

Only patients with remission under the strictest criteria had a decrease in the risk for death, said Dr. Scirè.

According to these criteria, patients who achieved at least 1 remission had a 25% reduction (hazard ratio [HR], 0.75) in mortality risk compared with those who did not achieve remission, he said.

Additionally, those with remission occurring within the first year had the highest risk reduction (HR, 0.66), whereas no significant risk reduction was found for patients who achieved remission in the second or third year.

The same analysis was performed with progressively less stringent criteria. "Applying the [moderate] definition, we found similar results but a less strong effect, and using the [least stringent] definition we lost all significant differences between patients in remission and not in remission," he said.

Asked to comment on the findings, Gareth Jones, PhD, from the University of Aberdeen, United Kingdom, told Medscape Medical News that it makes sense that remission would improve survival.

"The findings are not an enormous surprise," he said.

"If you're going to do well, you do well quickly and you stay well. If you do less well, it takes longer to reach a point of remission and your trajectory downhill is slightly steeper."

But there's likely more to it, Dr. Jones quickly added.

Several studies published by his group have linked chronic, widespread pain with increased mortality.

"Pain and fatigue and sleep problems go hand in hand," he said. "People who go into remission quicker are better able to maintain a more healthy lifestyle."

None of the speakers have disclosed any relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2012. Abstract #OP0126. Presented June 7, 2012.

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