PracticeUpdate: Dermatology & Rheumatology

AMERICAN COLLEGE OF RHEUMATOLOGY 2016 ANNUAL MEETING 20

Remission rates in RA have improved but earlier diagnosis, treatment needed Results of two retrospective reviews have revealed that, though remission rates of patients with rheumatoid arthritis have improved over the past few decades, time to diagnosis needs to be shortened and early effective treatment begun. J ustine Vix, MD, of University Hospital Poitiers, Poitiers, France, evaluated stable remission in rheumatoid arthritis over 7 years of follow-up in “real life” conditions and predictive factors of a positive outcome.

ACR 2016 11–16 NOVEMBER 2016 • WASHINGTON DC, USA The PracticeUpdate Editorial Team bring you our coverage of ACR 2016, featuring evidence supporting earlier RA diagnosis and treatment, statins to lower mortality risk in patients with ankylosing spondylitis and psoriatic athritis, longer biologics use in RA, and much more.

maintained in long-term remission. Targeted treatment with a combination of conventional and biologic disease-modifying antirheumatic drugs induced a higher rate of long-term remission. Jon T. Einarsson, MD, of Lund University, Lund, Sweden, investigated the impact of changing treatment goals in national guidelines on sustained remission, according to Disease Activity Score 28 <2.6 on at least two consecutive 6-month periods. He explained that emission has become a treatment goal in rheumatoid arthritis, especially since the introduction of biologic treatment in 1999. The Swedish quality registry is a nationwide registry for rheumatic diseases in which all 64 rheumatology units in the country participate. All adult patients with rheumatoid arthritis included in the registry from 1992–2013 and who were followed through 2014 with at least three visits were eligible (n=29,084). Median patient age was 59.6 years and 72% were female. Symptoms had begun from 1934 through 2012. For parts of the comparisons, only patients whose symptoms began between 1999 and 2009 were studied.

She explained that remission constitutes the best achievable state in patients with rheumatoid arthritis, and if remission is a goal, it need to be maintained. “I want to improve treatment,” Dr Vix commented, “and optimise our patients’ best chance of a good quality of life, avoid pain, joint damage, bone erosion, deformation, and impaired functioning.” Dr Vix and colleagues analysed clinical, biological, immunogenetic, and radiographic records of 364 patients with active rheumatoid arthritis. All fulfilled American College of Rheumatology criteria and were seen in 2008. Mean patient age was 62.9 years. Patients were seen at least once a year in an outpatient clinic or during hospitalisation. Data were collected through 2015. Data were available for 232 patients (75%) who were followed for 7 years. Ninety-seven patients (31%) achieved American College of Rheumatology/European League Against Rheumatism remission, defined as Disease Activity Score 28 <2.6, after 1 year. A total of 133 patients (57%) achieved remission. Mean activity per Disease Activity Score 28 was 3.44 after 1 year and decreased to 2.67 after 7 years of follow-up. Corticosteroids were stopped in 38% of the cohort. The remission rate (Disease Activity Score 28 <2.6) was 31% after 1 year and remained stable in 76% of patients. Including patients not in remission after 1 year, 48.6% achieved remission during follow up and 17% were still in low disease activity (Disease Activity Score 28 <3.2) in 2015. Long-term remission was more frequent when conventional disease-modifying antirheumatic drugs were given with biological disease- modifying antirheumatic drugs, especially anti- tumour necrosis factor agents. Dr Vix concluded that 76% of patients who achieved remission after 1 year of treatment

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PRACTICEUPDATE RHEUMATOLOGY & DERMATOLOGY