The likelihood of attaining and maintaining DMARD-free remission for various (rheumatoid) arthritis phenotypes

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Objectives: The objective of this study was to compare DMARD-free remission rates (DFRs) and sustained DFRs (SDFRs), defined as, respectively, DFR for ≥6 months and ≥1 year, after 2 and 5 years, between three clinical arthritis phenotypes: undifferentiated arthritis (UA), autoantibody-negative (RA-) and autoantibody-positive RA (RA+). Methods: All UA (n = 130), RA- (n = 176) and RA+ (n = 331) patients from the tREACH trial, a stratified single-blinded trial with a treat-to-target approach, were included in the study. (S)DFR comparisons between phenotypes after 2 and 5 years were performed with logistic regression. Medication use and early and late flares (DAS ≥ 2.4), defined as at <12 months and >12 months after reaching DMARD-free remission (DFR), respectively, were also compared. Cox proportional hazard models were used to evaluate potential predictors for (S)DFR. Results: Over the study periods of 2 and 5 years, less DFR was seen in RA+ (17.2-25.7%), followed by RA- (28.4-42.1%) and UA patients (43.1-58.5%). This also applied for SDFR over the 2- and 5-year periods in these three clinical arthritis phenotypes (respectively, 7.6% and 21.4%; 20.5% and 38.1%; and 35.4% and 55.4%). A flare during tapering was seen in 22.7% of patients. Of the patients in DFR, 7.5% had an early flare and 3.4% a late flare. Also, more treatment intensifications occurred in RA+ compared with RA- and UA. We found that higher baseline DAS, ACPA positivity, higher BMI and smoking were negatively associated with (S)DFR, while clinical phenotype (reference RA+), short symptom duration (<6 months) and remission within 6 months were positively associated with (S)DFR. Conclusion: Long-term clinical outcomes differ between UA, RA- and RA+. These data reconfirm that RA can be subdivided into the aforementioned clinical phenotypes and that treatment might be best stratified upon these phenotypes, although validation is needed. Trial registration: ISRCTN,, ISRCTN26791028.

Original languageEnglish
Pages (from-to)2275-2284
Number of pages10
JournalRheumatology (United Kingdom)
Issue number6
Publication statusPublished - Jun 2022

Bibliographical note

Funding: The tREACH trial was supported by an unrestricted grant from Pfizer bv. [WI229707]. Pfizer had no involvement in the study design; in collection, analysis or interpretation of data; in writing of the report; or in the decision to submit for publication. The corresponding author had full access to all data and had final responsibility for the decision to submit the manuscript for publication. Data management was sponsored by the Dutch Arthritis Society [16–3-101].

Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.


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