title: Comparison of the long-term outcome for patients with rheumatoid arthritis with persistent moderate disease activity or disease remission during the first year after diagnosis: data from the ESPOIR cohort.
abstract: OBJECTIVE
  To investigate if patients with early RA with persistent moderate disease activity during the first year after diagnosis have a worse 3-5 year outcome than those who achieve sustained clinical remission within the first year, in a daily life setting.
  
  
  METHODS
  The ESPOIR cohort included patients with early arthritis of <6 months' duration. Treatment was the standard of care. We had 5-year follow-up data for 573 patients. This study compared patients who had persistent moderate disease activity (Disease Activity Score in 28 joints (DAS28)>3.2 and ≤5.1) at both the 6- and 12-month visits, with those who were in sustained DAS28 remission. The primary outcome was radiographic progression at the 36-month visit. Secondary endpoints were clinical remission (DAS28 score, Simplified Disease Activity Index, ACR/EULAR criteria), Health Assessment Questionnaire-Disability Index (HAQ-DI) and number of missed workdays at months 36 and 60. A Fisher exact test was used to compare categorical variables, and the Kruskal-Wallis test for quantitative variables. Logistic regression analysis was used to determine predictors of outcome.
  
  
  RESULTS
  Patients were aged 48.1±12.5 years and their duration of symptoms was 103.2±52.1 days. Mean baseline DAS28 was 5.1±1.3. Persistent moderate disease activity (107 patients) rather than sustained remission (155 patients) during the first year was associated with increased radiographic disease progression at 3 years (OR=1.99 (95% CI 1.01 to 3.79)), increased HAQ-DI at 3 and 5 years (5.23 (2.81 to 9.73) and 4.10 (2.16 to 7.80), respectively), a 7-11 times smaller chance of achieving clinical remission and a five times greater number of missed workdays.
  
  
  CONCLUSIONS
  Patients with early RA with persistent moderate disease activity during the first year had a worse outcome than patients who achieved sustained clinical remission. Persistent moderate disease activity affects long-term structure, remission rate and functional and work disability. Such patients may benefit from intensive treatment.
authors.affiliation: Lapeyronie Hospital, Montpellier I University, Montpellier: UMR 5535, France.
authors.forename: B
authors.initials: B
authors.lastname: Combe
authors.affiliation: Pfizer, PIO, Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Logeart
authors.affiliation: Lapeyronie Hospital, Montpellier I University, Montpellier: UMR 5535, France.
authors.forename: M C
authors.initials: MC
authors.lastname: Belkacemi
authors.affiliation: Paris-Pitié Salpêtrière University Hospital, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Dadoun
authors.affiliation: Département de Rhumatologie, Hôpital Pellegrin, CHU Bordeaux, Unité sous Contrat, Infections à Mycoplasmes et à Chlamydia chez l'Homme, Université de Bordeaux, Bordeaux, France.
authors.forename: T
authors.initials: T
authors.lastname: Schaeverbeke
authors.affiliation: Lapeyronie Hospital, Montpellier I University, Montpellier: UMR 5535, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Daurès
authors.affiliation: Medecine Faculty and Rheumatology B dept, Paris-Descartes University, UPRES-EA 4058; APHP,Cochin Hospital, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Dougados
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D001799:Blood Sedimentation; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D010456:Peptides, Cyclic / Q000276:immunology; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D010456:Peptides, Cyclic; D014409:Tumor Necrosis Factor-alpha; C487763:cyclic citrullinated peptide; D008727:Methotrexate
keywords: Early Rheumatoid Arthritis; Outcomes research; Rheumatoid Arthritis