The importance of achieving remission in patients with rheumatoid arthritis
Authors:
K. Pavelka
Authors‘ workplace:
Revmatologický ústav Praha
Published in:
Čes. Revmatol., 27, 2019, No. 4, p. 218-226.
Category:
Review Article
Overview
According to the recommendations of EULAR/ACR and the Czech Society for Rheumatology, the goal of treatment for each patient with rheumatoid arthritis (RA) is to achieve remission. Alternatively, in patients with long-standing disease to achieve low disease activity. The subject of the first part of this review is to analyze the most commonly used remission definitions, including DAS 28 CRP or DAS 28 ESR, SDAI and CDAI. It is also emphasized that the temporal parameters for assessing remission whether it is a one-time, cumulative achievement or so-called sustained remission (defined as DAS 28 < 2.6 for at least 6 months) must always be reported. The next section discusses the occurrence of remission in routine clinical practice, with evidence being obtained primarily from registries and long-term cohort studies. Therapeutic strategies can also influence the achievement of remission, while the application of the T2T principle clearly increases remission frequency. Factors influencing the achievement of remission have been studied. The most important positive predictors of remission include the use of biological drugs, lower baseline activity, shorter disease duration, biologically naïve patients and some others. In the end, the issue of why to strive for remission at all is discussed. The reasons are: improving the quality of life, improving physical function, reducing cardiovascular risk, reducing the need for major orthopedic interventions, and increasing labor productivity. Finally, some new data is presented suggesting remission for some Janus kinase inhibitors may be more frequent than for TNF inhibitors.
Keywords:
rheumatoid arthritis – treat to target – remission – biological drugs
Sources
1. Kvien T. Epidemiology and burden of illness rheumatoid arthritis. Pharmaco Economics 2004; 22: 1–12.
2. Smolen J, Landewe R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease modifying antirheumatic drugs 2016 update. Ann Rheum Dis 2017; 76: 960–977.
3. Prevoo MLL, Vant Hof MA, Kuper HH, et al. Modified disease activity scores that include twenty eight – joint counts development and validation in prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995; 38: 44–48.
4. Smolen J, Breedveld FC, Shiff MH, et al. A simplified disease activity index for rheumatoid arthritis for use in clinical practise. Rheumatology Oxford 2003; 42: 244–257.
5. Felson DT, Smolen JS, Wells G, et al. ACR/ EULAR provisional definition of remission in rheumatoid arthritis for clinical trials Ann Rheum Dis 2011; 70: 404–413.
6. Aga AB, Lie E, Uhlig T, et al. Time trends in disease activity, response and remission rates in rheumatoid arthritis during the past decade. Results from the NOR-DMARD study 2000–2010. Ann rheum Dis 2015; 74: 381–388.
7. Combe B, Richeval N, Benessiano J, et al. Five-year favourable outcome of patients with early rheumatoid arthritis in the 2000 data from ESPOIR cohort. J Rheumatol 2013; 40: 1650–1657.
8. Kavanaugh A, Keystone E, Greenverg JD, et al. Benefit of biologics initiation in moderate versus severe rheumatoid arthritis evidence from United States Registry. Rheumatology 2017; 56: 1095–1101.
9. Listing J, Strangfeld A, Rau R, et al. Clinical and functional remission: Even though biologics are superior to conventional DMARDs overall success rates remain low- results from RABBIT, the German Biologics Register. Arthritis Res Ther 2006; 7: R66.
10. Einarsson JT, Willim M, Ernestam S, et al. Prevalence of sustained remission in rheumatoid arthritis: impact of criteria sets and disease duration, a nationwide study in Sweden. Rheumatology 2019; 58: 227–236.
11. Smolen J, Kay J, Doyle MK, et al. Golimumab in patients with active rheumatoid arthritis after treatment with tumour necrosis factor α inhibitors (GO-AFTER study): a multicentre, randomised, double-blind, placebo-controlled, phase III trial. Lancet 2009; 374: 210–221.
12. Katchamart W, Johnson S, Luci Lin H-J, et al. Predictors for remission in rheumatoid arthritis patients: a systematic review. Arthritis Car Research 2010; 62: 1128–1143.
13. Hamann PDH, Pauling JD, McHugh N, et al. Predictors, demographics and frequency of sustained remission and low disease activity in anti-tumour necrosis factor-treated rheumatoid arthritis patients. Rheumatology (Oxford) 2019; doi: 10.1093/rheumatology/kez188
14. Smolen JS, Aletaha D, Bijlsma JW, et al. Treating rheumatoid arthritis to target: recommendation of an international task force. Ann Rheum Dis 2010; 69: 631–637.
15. Smolen J, Breedveld FC, Burmestr G, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of international task force. Ann Rheum 2016; 75(1): 3–15.
16. Versteeg GA, Steunebrink LM, Vonkeman HE, et al. Long-term disease and patient- reported outcomes of a continuous treat to target approach in patients with early rheumatoid arthritis in daily clinical practise. Clinical Rheum 2018; 37: 1189–1197.
17. Lampropoulos CE, Orfanos P, Manousakis MN, et al. Treat to target therapy in patients with rheumatoid arthritis in more efficacious and safe compared to delayed initiation of biologics. Clin Exp Rheumatol 2017; 35(2): 192–200.
18. Yu Ch, Jin S, Wang Y, et al. Remission rate and predictors of remission in patients with rheumatoid arthritis under treat-to-target strategy in real-world studies: a systematic review and meta-analysis. Clin Rheumatol 2019; 38: 727–738.
19. Linde L, Sorensen J, Ostergaard M, et al. Does clinical remission lead to normalization of EQ-5D in patients with rheuma-toid arthritis and is selection of remission criteria important? J Rheumatol 2010; 37: 285–290.
20. Radner H, Smolen JS, Aletaha D. Remission in rheumatoid arthritis: benefit over low disease activity in patient-reported outcomes and costs. Arthritis Res Ther 2014; 16(1): R56.
21. Puolakka K, Kautiainen H, Möttönen T, et al. Early suppression of disease activity is essential for maintenance of work capacity in patients with recent-onset rheumatoid artritis. Arthritis Rheum 2005; 52: 36–41.
22. Nikiphorou E, Norton S, Young A, Carpenter L, Dixey J, Walsh DA, Kiely P; ERAS and ERAN. Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds. Ann Rheum Dis 2016; 75(12): 2080–2086.
23. Burggraaf B, van Breukelen-vander Stoep DF, de Vries MA, et al. Effect of a treat-to-target intervention of cardiovascular risk factors on subclinical and clinical atherosclerosis in rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis 2019; 78: 335–341.
24. Fleischmann R, Mysler E, Hall S, Kivitz AJ, Moots RJ, Luo Z, et al. Efficacy and safety of tofacitinib monotherapy, tofacitinib with methotrexate, and adalimumab with methotrexate in patients with rheumatoid arthritis (ORAL Strategy): a phase 3b/4, double-blind, head-to-head, randomised controlled trial. Lancet 2017; 390(10093): 457–468.
25. Taylor PC, Keystone EC, van der Heijde D, Weinblatt ME, Del Carmen Morales L, Reyes Gonzaga J, et al. Baricitinib versus placebo or adalimumab in rheumatoid arthritis. N Engl J Med 2017; 376(7): 652–662.
26. Fleischmann R, Pangan AL, Mysler E, Bessette L, Peterfy C, Durez P, et al. Upadacitinib versus placebo or adalimumab in patients with rheumatoid arthritis and an inadequate response to methotrexate: results of a phase III, double-blind, randomized controlled trial. Arthritis Rheumatology 2019; 71(11): 1788–1800.
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Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
2019 Issue 4
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