Comparable Clinical and Radiographic Outcomes among DAS28-ESR-based Remission Criteria and SDAI, CDAI, and ACR/EULAR Boolean definitions in patients with Established Rheumatoid Arthritis in Clinical Practice. Observational Study of 5 years of Follow-Up

Abstract

Objective To compare long-term clinical and radiographic outcomes among five sets of remission criteria [four clinical and one Ultrasound (US)-based] in a cohort of RA patients in a clinical care setting. Methods RA patients in remission (DAS28-ESR <2.6) were selected. Hand US assessments were performed, and serum levels of inflammation/angiogenesis biomarkers were determined at baseline. Changes in baseline treatment and radiographic progression, defined as the variation in the modified Sharp van der Heijde score (mSHS) at 5 years, were analyzed. To define remission, five different concepts were used, as follows: DAS28-ESR<2.6, SDAI<3.3, CDAI<2.8, Boolean criteria and score Power Doppler (PD)=0.Results Eighty-seven patients with DAS28-ESR<2.6 were included. One third fulfilled SDAI (33.3%), CDAI (31%) and Boolean (35.6%) remission criteria and 25.3% had no PD signal in the US evaluation. 26 patients (29.9%) changed the therapy, ranging from 13.6% (PD remission) to 33.3% (CDAI remission) (p=0.11). Serum levels of ANG (p=0.015) and TNFa (p=0.025) were significantly lower in patients with Boolean remission, whereas IL-18 levels were significantly lower in those with PD remission (p=0.049). Patients without PD in the US assessment had significantly lower mSHS erosion progression (p=0.014) at 5 years. Conclusions Patients with established RA in DAS28-ESR remission had comparable clinical and radiographic outcomes than SDAI, CDAI and Boolean definitions in a clinical care setting. US remission remained as the closest to structural damage abrogation.