title: Remission in early, aggressive rheumatoid arthritis: a multicentre prospective observational Italian study ARPA (Artrite Reumatoide Precoce Aggressiva).
abstract: OBJECTIVE
  To provide a survey of disease activity in patients treated with standard care in Italian clinical practice.
  
  
  METHODS
  This was an observational prospective cohort study in patients with early, aggressive rheumatoid arthritis (RA; duration ≤2 years but ≥6 weeks; DAS28 >3.2) naïve to anti-tumour necrosis factor (TNF) therapy who were treated with disease-modifying anti-rheumatic drugs (DMARDs) and/or biologics according to standard practice at 15 Italian ARPA (Artrite Reumatoide Precoce Aggressiva) centres. Patients were evaluated at baseline and after 6, 12 and 24 months. The primary endpoint was the proportion of patients achieving remission, as defined by disease activity score in 28 joints (DAS28) <2.6, after 1 year.
  
  
  RESULTS
  Among the 152 patients enrolled, 92 were evaluable after 1 year and 77 after 2 years for DAS28. At baseline, patients had a mean DAS28 of 6.1±1.0. At 12 months, 62.6% of patients were treated with DMARDs (in monotherapy or in combination), and 37.4% with anti-TNFs (in monotherapy or in association with DMARDs). At 24 months, 35.1% were receiving anti-TNF therapy. The rate of DAS28 remission rates at 12 months and 24 months were 28.3% (95% confidence interval [CI] 19.1-37.5) and 41.6% (95% confidence interval [CI] 30.6-52.6), respectively.
  
  
  CONCLUSIONS
  The remission rate was lower at 12 months compared with previous large randomised clinical trials for early, aggressive RA, but significantly improved at 24 months. These results suggest that patients in real-world clinical settings in Italy may experience a delay in receiving the best possible care.
authors: Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Roma, Italy. fulviaceccarelli@gmail.com
authors: Fulvia
authors: F
authors: Ceccarelli
authors: Carlo
authors: C
authors: Perricone
authors: Francesco
authors: F
authors: Trotta
authors: Giovanna
authors: G
authors: Cuomo
authors: Raffaele
authors: R
authors: Pellerito
authors: Gianfilippo
authors: G
authors: Bagnato
authors: Fausto
authors: F
authors: Salaffi
authors: Roberto
authors: R
authors: Caporali
authors: Maurizio
authors: M
authors: Cutolo
authors: Mauro
authors: M
authors: Galeazzi
authors: Ugo
authors: U
authors: Fiocco
authors: Giovanni
authors: G
authors: Lapadula
authors: Stefano
authors: S
authors: Bombardieri
authors: Girolamo
authors: G
authors: Bianchi
authors: Roberto
authors: R
authors: Gorla
authors: Anna Rita
authors: AR
authors: Giardina
authors: Gaia
authors: G
authors: Gallo
authors: Angela Maria
authors: AM
authors: Giardino
authors: Guido
authors: G
authors: Valesini
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015331:Cohort Studies; D018450:Disease Progression; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007558:Italy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha