title: Sustained clinical remission in rheumatoid arthritis: prevalence and prognostic factors in an inception cohort of patients treated with conventional DMARDS.
abstract: OBJECTIVE
  Clinical remission is now a realistic goal in managing RA following the introduction of biologic agents. As there are limited data on sustained remission in conventionally treated RA, this study examines prevalence and predictive factors of sustained remission in a pre-biologic inception cohort of RA.
  
  
  METHODS
  Patients with recent onset RA and before use of DMARDs were recruited from nine centres. Standard clinical and radiological assessments were recorded at baseline and yearly. Point remission was defined by DAS of <1.6, and sustained remission if DAS was <1.6 at all 3-, 4- and 5-year follow-ups. Sustained remission was compared with baseline features, with mortality and with radiological and functional progression in 704 patients.
  
  
  RESULTS
  Point remission at 3, 4 and 5 years was 25, 26 and 22%, respectively. Eleven per cent (n = 78) had sustained remission. Male sex, short duration of symptoms and less tender joints at baseline were independent predictors of sustained remission. These patients had fewer DMARD therapies and less radiographic progression by 5 years. Mean HAQ decreased from 0.79 to 0.13 (P < 0.001) in sustained remission, compared with an increase from 0.92 to 1.1 (P < 0.001) in the non-remission group.
  
  
  CONCLUSIONS
  Sustained clinical remission by 5 years with conventional DMARDs was 11%, half as likely as point remission. Prognostic factors were similar to comparable studies and simple to measure. Patients in sustained clinical remission showed less structural damage and better functional outcomes.
authors.affiliation: ERAS, c/o Rheumatology Department, St Albans City Hospital, Waverley Road, St Albans AL3 5PN, UK. eras@whht.nhs.uk
authors.forename: Keeranur
authors.initials: K
authors.lastname: Jayakumar
authors.forename: Sam
authors.initials: S
authors.lastname: Norton
authors.forename: Josh
authors.initials: J
authors.lastname: Dixey
authors.forename: David
authors.initials: D
authors.lastname: James
authors.forename: Andrew
authors.initials: A
authors.lastname: Gough
authors.forename: Peter
authors.initials: P
authors.lastname: Williams
authors.forename: Peter
authors.initials: P
authors.lastname: Prouse
authors.forename: Adam
authors.initials: A
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004812:Epidemiologic Methods; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011379:Prognosis; D012074:Remission Induction; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids