Prediction of long-term drug-free outcomes in anti-citrullinated protein antibody (ACPA)-positive and ACPA-negative rheumatoid arthritis by combined clinical and ultrasound assessment of residual disease: a 5-year prospective study
Authors' conclusion
Long-term DF remission is attainable in a niche subset of ACPA-negative RA. Examining clinical and subclinical residual synovial abnormalities during remission allows for effective preemptive identification of this subset in real life.
Study context
- Population
- Rheumatoid arthritis (RA) patients from the Pavia early arthritis clinic (2009–2021) in remission after DAS-driven methotrexate (MTX) monotherapy, followed drug-free for 5 years after MTX discontinuationof 761 early arthritis clinic (EAC) RA patients
- Participants
- 132 patients
- Exposure
- ACPA-positive vs ACPA-negative RA after MTX discontinuation in remission
- ACPA-negative in Simplified Disease Activity Index (SDAI) remission without US-GS alterationn = 59reference
- Outcome
- Time-to-flare after MTX discontinuation
- Follow-up
- 5 years
Methodological details5-year prospective, multivariable Cox regression, single early arthritis clinic
- 5-year prospective
- Multivariable Cox regression
- Single early arthritis clinic
Main finding
As reported in the abstract
Independent predictors of flare (multivariate Cox regression, whole cohort)
ACPA positivity, HR
4.20 (2.37 to 7.44) (95% CI)
Hands' joints with US-GS alterations (GS>1), HR
2.18 (1.20 to 3.93) (95% CI)
Flares
62
Time to flare, median (range), months
9
3–60
Observational data: associations, not effects.
Further findings
| Outcome | ACPA-positive in SDAI remission | ACPA-negative in SDAI remission without US-GS alteration |
|---|---|---|
| Flare-free survival estimate · 5 years | 6.4% (95% CI 1.2–35.7) | 78.2% (95% CI 67.4–90.8) |
Flare-free survival estimate · 5 years
- ACPA-negative subset without US-GS alteration showed no evidence of radiographic progression and functional deterioration
Original publication
Prediction of long-term drug-free outcomes in ACPA-positive and ACPA-negative rheumatoid arthritis by combined clinical and ultrasound assessment of residual disease: a 5-year prospective study. RMD Open. Published 29 January 2025. doi:10.
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