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
Objective To delineate, within the framework of current clinical practice and criteria, the sustainability of first-line immuno-suppressive treatment discontinuation in rheumatoid arthritis (RA) and the impact of residual disease in remission on long-term drug-free (DF) outcomes.Methods RA patients,...
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BMJ Publishing Group
2025-01-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/11/1/e005079.full |
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| author | Carlomaurizio Montecucco Garifallia Sakellariou Claudia Alpini Catherine Klersy Serena Bugatti Ludovico De Stefano Emanuele Bozzalla Cassione Antonio Manzo Blerina Xoxi Terenzj Luvaro Ylenia Sammali |
| author_facet | Carlomaurizio Montecucco Garifallia Sakellariou Claudia Alpini Catherine Klersy Serena Bugatti Ludovico De Stefano Emanuele Bozzalla Cassione Antonio Manzo Blerina Xoxi Terenzj Luvaro Ylenia Sammali |
| author_sort | Carlomaurizio Montecucco |
| collection | DOAJ |
| description | Objective To delineate, within the framework of current clinical practice and criteria, the sustainability of first-line immuno-suppressive treatment discontinuation in rheumatoid arthritis (RA) and the impact of residual disease in remission on long-term drug-free (DF) outcomes.Methods RA patients, referring to the Pavia early arthritis clinic (EAC) between 2009 and 2021 and achieving remission after Disease Activity Score-driven methotrexate (MTX) monotherapy, were recruited. Eligible patients underwent DF follow-up at 3-month intervals over 5 years after MTX discontinuation. Pre-selected clinical, serological and ultrasound (US) exposure variables at MTX withdrawal were analysed using multivariable Cox regression to predict time-to-flare.Results Of 761 EAC patients with RA, 132 started DF follow-up (person-months: 3678). 62 experienced a flare after a median (range) of 9 (3–60) months, resulting in a progressive decline in flare-free survival throughout the observation period. Whole-cohort multivariate Cox regression identified anti-citrullinated protein antibody (ACPA) positivity (HR: 4.20, 95% CI 2.37 to 7.44) and hands’ joints with grey scale (US-GS) alterations (GS>1; HR: 2.18, 95% CI 1.20 to 3.93) as independent predictors. ACPA-positive patients in Simplified Disease Activity Index (SDAI) remission displayed a flare-free survival estimate at 5 years of 6.4% (95% CI 1.2 to 35.7) versus 78.2% (95% CI 67.4 to 90.8) for ACPA-negative patients in SDAI remission without residual US-GS alteration in hands’ joints (n=59); the latter group showing no evidence of radiographic progression and functional deterioration.Conclusions 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. |
| format | Article |
| id | doaj-art-b775e0f9a74a4e13981fb6ed67e9b415 |
| institution | Kabale University |
| issn | 2056-5933 |
| language | English |
| publishDate | 2025-01-01 |
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| series | RMD Open |
| spelling | doaj-art-b775e0f9a74a4e13981fb6ed67e9b4152025-01-31T19:50:10ZengBMJ Publishing GroupRMD Open2056-59332025-01-0111110.1136/rmdopen-2024-005079Prediction 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 studyCarlomaurizio Montecucco0Garifallia Sakellariou1Claudia Alpini2Catherine Klersy3Serena Bugatti4Ludovico De Stefano5Emanuele Bozzalla Cassione6Antonio Manzo7Blerina Xoxi8Terenzj Luvaro9Ylenia Sammali10Arthritis Research Clinic (ARC), Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, ItalyRheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Universita di Pavia, Pavia, ItalyLaboratory of Biochemical-Clinical Analyses, Fondazione IRCCS Policlinico San Matteo, Pavia, ItalyBiostatistics and Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, ItalyRheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Universita di Pavia, Pavia, ItalyRheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Universita di Pavia, Pavia, ItalyRheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Universita di Pavia, Pavia, ItalyRheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Universita di Pavia, Pavia, ItalyRheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Universita di Pavia, Pavia, ItalyRheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Universita di Pavia, Pavia, ItalyRheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Universita di Pavia, Pavia, ItalyObjective To delineate, within the framework of current clinical practice and criteria, the sustainability of first-line immuno-suppressive treatment discontinuation in rheumatoid arthritis (RA) and the impact of residual disease in remission on long-term drug-free (DF) outcomes.Methods RA patients, referring to the Pavia early arthritis clinic (EAC) between 2009 and 2021 and achieving remission after Disease Activity Score-driven methotrexate (MTX) monotherapy, were recruited. Eligible patients underwent DF follow-up at 3-month intervals over 5 years after MTX discontinuation. Pre-selected clinical, serological and ultrasound (US) exposure variables at MTX withdrawal were analysed using multivariable Cox regression to predict time-to-flare.Results Of 761 EAC patients with RA, 132 started DF follow-up (person-months: 3678). 62 experienced a flare after a median (range) of 9 (3–60) months, resulting in a progressive decline in flare-free survival throughout the observation period. Whole-cohort multivariate Cox regression identified anti-citrullinated protein antibody (ACPA) positivity (HR: 4.20, 95% CI 2.37 to 7.44) and hands’ joints with grey scale (US-GS) alterations (GS>1; HR: 2.18, 95% CI 1.20 to 3.93) as independent predictors. ACPA-positive patients in Simplified Disease Activity Index (SDAI) remission displayed a flare-free survival estimate at 5 years of 6.4% (95% CI 1.2 to 35.7) versus 78.2% (95% CI 67.4 to 90.8) for ACPA-negative patients in SDAI remission without residual US-GS alteration in hands’ joints (n=59); the latter group showing no evidence of radiographic progression and functional deterioration.Conclusions 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.https://rmdopen.bmj.com/content/11/1/e005079.full |
| spellingShingle | Carlomaurizio Montecucco Garifallia Sakellariou Claudia Alpini Catherine Klersy Serena Bugatti Ludovico De Stefano Emanuele Bozzalla Cassione Antonio Manzo Blerina Xoxi Terenzj Luvaro Ylenia Sammali 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 |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://rmdopen.bmj.com/content/11/1/e005079.full |
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