COMMENTARY

How Early Is 'Early Enough' in the Treatment of RA?

Kevin Deane, MD, PhD

Disclosures

February 20, 2015

Evaluating Relationships Between Symptom Duration and Persistence of Rheumatoid Arthritis: Does a Window of Opportunity Exist? Results on the Leiden Early Arthritis Clinic and ESPOIR Cohorts

van Nies JA, Tsonaka R, Gaujoux-Viala C, Fautrel B, van der Helm-van Mil AH
Ann Rheum Dis. 2015 Jan 5. [Epub ahead of print]

Study Summary

In this study, van Nies and colleagues used data obtained from two groups of patients with rheumatoid arthritis (RA), as defined by the 1987 American College of Rheumatology criteria, who were treated with disease-modifying antirheumatic drugs (DMARDs): the Leiden Early Arthritis Cohort (EAC) (n = 738) from The Netherlands, and the Evaluation et Suivi de POlyarthrites Indifférenciées Récentes (ESPOIR) cohort (n = 533) from France. The primary outcome was DMARD-free remission, defined as absence of joint swelling after cessation of DMARDs after at least 1 year and up to 5 years. This was deemed by the authors to be the best proxy for a "cure" of RA.

During 5 years of follow-up, 11.5% and 5.4% of patients achieved DMARD-free remission in the EAC and ESPOIR groups, respectively. When anti-citrullinated peptide antibody (ACPA) status was evaluated, 67 (19.9%) ACPA-negative patients in the EAC group achieved DMARD-free remission vs only 13 (3.5%) ACPA-positive patients; in the ESPOIR group, only 3 (1.1%) ACPA-positive patients achieved DMARD-free remission.

The duration of symptoms that best predicted DMARD-free remission was 14.9 weeks among the EAC patients and 19.1 weeks among the ESPOIR patients. Beyond these periods, the rates of DMARD-free remission were lower, leading the authors to conclude that there may be a defined period in early RA that is most susceptible to treatment.

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