REVIEW - Remission in early RA

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J Rheumatol. 2010 Jul;37(7):1444-53. Epub 2010 Jun 1.

Remission in early rheumatoid arthritis.

Ma MH, IC, Kingsley GH, DL.

Department of Rheumatology, GKT School of Medicine, King's College

London, London, UK.

Abstract

OBJECTIVE: We systematically reviewed remission as an outcome measure

in observational studies and randomized controlled trials (RCT) in

early rheumatoid arthritis (RA). Our objectives were to identify its

frequency using different criteria, to determine the influence of

different treatment strategies on remission, and to review the effects

of remission on radiological outcomes.

METHODS: Pubmed, Medline and Embase were searched using the following

terms: Early Rheumatoid Arthritis or Early RA combined with Remission,

Treatment, anti-Tumor Necrosis Factor (TNF) or Disease-modifying

Antirheumatic Drugs (DMARD). Remissions were reported using American

College of Rheumatology (ACR) criteria and Disease Activity Score

(DAS) criteria.

RESULTS: Seventeen observational studies (4762 patients) reported

remission in 27% of patients, 17% by ACR criteria and 33% by DAS

criteria. Twenty RCT (4 comparing DMARD monotherapies, 13 comparing

monotherapy with combination therapies, 3 comparing combination

therapies) enrolled 4290 patients. ACR remissions occurred in 16%

receiving DMARD monotherapy and 24% combination therapies (random

effects OR 1.69, 95% CI 1.12-2.36). DAS remissions occurred in 26% and

42%, respectively (OR 2.01, 95% CI 1.46-2.78). Observational studies

showed continuing radiological progression despite remission. RCT

showed less radiological progression in remission when treated with

combination therapy compared to monotherapies.

CONCLUSION: Remission is a realistic treatment goal in early RA.

Combination therapies using DMARD with or without TNF inhibitors

increase remissions. Radiological progression occurred in remission

but is reduced by combination therapies. ACR and DAS remission

criteria are not directly comparable and standardization is needed.

PMID: 20516031

http://www.ncbi.nlm.nih.gov/pubmed/20516031

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