title: Early remission is associated with improved survival in patients with inflammatory polyarthritis: results from the Norfolk Arthritis Register.
abstract: OBJECTIVE
  This study aimed to evaluate whether the early achievement of clinical remission influences overall survival in an inception cohort of patients with inflammatory polyarthritis (IP).
  
  
  METHODS
  Consecutive early IP patients, recruited to a primary care based inception cohort from 1990 to 1994 and from 2000 to 2004 were eligible for this study. Remission was defined as absence of clinically detectable joint inflammation on a 51-joint count. In sensitivity analyses, less stringent definitions of remission were used, based on 28-joint counts. Remission was assessed at 1, 2 and 3 years after baseline. All patients were flagged with the national death register. Censoring was set at 1 May 2011. The effect of remission on mortality was analysed using the Cox proportional hazard regression model, and presented as HRs and 95% CIs.
  
  
  RESULTS
  A total of 1251 patients were included in the analyses. Having been in remission at least once within the first 3 years of follow-up was associated with a significantly lower risk of death: HR 0.72 (95% CI 0.55 to 0.94). Patients who were in remission 1 year after the baseline assessments and had persistent remission over time had the greatest reduction in mortality risk compared with patients who never achieved remission within the first 3 years of follow-up: HR 0.58 (95% CI 0.37 to 0.91). Remission according to less stringent definitions was associated with progressively lower protective effect.
  
  
  CONCLUSIONS
  Early and sustained remission is associated with decreased all-cause mortality in patients with IP. This result supports clinical remission as the target in the management of IP.
authors.affiliation: Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK Rheumatology Unit, IRCCS San Matteo Foundation, Pavia, Italy Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Scirè
authors.affiliation: Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Lunt
authors.affiliation: Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: Tarnya
authors.initials: T
authors.lastname: Marshall
authors.affiliation: Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester, UK.
authors.forename: Deborah P M
authors.initials: DP
authors.lastname: Symmons
authors.affiliation: Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: Suzanne M M
authors.initials: SM
authors.lastname: Verstappen
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001168:Arthritis / Q000188:drug therapy* / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011379:Prognosis; D012042:Registries; D012074:Remission Induction; D012720:Severity of Illness Index; D009626:Terminology as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: Arthritis; Disease Activity; Early Rheumatoid Arthritis; Epidemiology