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. 2014 Sep;73(9):1677-82.
doi: 10.1136/annrheumdis-2013-203339. Epub 2013 Jun 7.

Early remission is associated with improved survival in patients with inflammatory polyarthritis: results from the Norfolk Arthritis Register

Carlo A Scirè  1 , Mark Lunt  2 , Tarnya Marshall  3 , Deborah P M Symmons  4 , Suzanne M M Verstappen  2
Affiliations
Free PMC article

Early remission is associated with improved survival in patients with inflammatory polyarthritis: results from the Norfolk Arthritis Register

Carlo A Scirè et al. Ann Rheum Dis. 2014 Sep.
Free PMC article

Abstract

Objectives: 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.

Keywords: Arthritis; Disease Activity; Early Rheumatoid Arthritis; Epidemiology.

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