The number of risk factors for persistent disease determines the clinical course of early arthritis

tREACH group investigators, N Luurssen-Masurel*, A E A M Weel, G H Koc, J M W Hazes, P H P de Jong

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
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OBJECTIVES: Management of early arthritis is based upon early recognition of individuals at high risk of developing persistent arthritis. Therefore, this study investigates whether the number of risk factors for persistent disease or treatment determines the clinical course of early arthritis by comparing the chance at (sustained) DMARD-free remission ((S)DFR) after 2 years follow-up.

METHODS: Data from the tREACH trial, a stratified single-blinded multicentre strategy trial with a treat-to-target approach were used. We selected all patients with ≥1 swollen joint who did not fulfil 1987 and/or 2010 criteria for RA. The number of risk factors present; autoantibody-positivity, polyarthritis (>4), erosive disease and elevated acute phase reactants, determined risk group stratification. Multivariate logistic regression analyses were performed with (S)DFR as dependent variables and baseline disease activity score (DAS), treatment, symptom duration and number of risk factors present as independent variables.

RESULTS: In total, 130 early arthritis patients were included and respectively 31, 66 and 33 had 0, 1 and ≥2 risk factors present. DFR rates were respectively 74%, 48% and 45% for early arthritis patients with 0, 1 and ≥2 risk factors present. In accordance SDFR rates were 61%, 32% and 30%. In our logistic model (S)DFR was not influenced by the initial treatment strategies when stratified for risk groups.

CONCLUSION: The chance at (S)DFR in early arthritis diminishes when more risk factors are present, which is irrespective of the given initial treatment. Our data point out to a stratified management approach in early arthritis based on their risk profile, but validation is needed.


Original languageEnglish
Pages (from-to)3617-3627
Number of pages11
JournalRheumatology (Oxford, England)
Issue number8
Publication statusPublished - Aug 2021

Bibliographical note

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

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


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