Sustaining remission in rheumatoid arthritis and identifying suitable patients for tapered treatment

This study examined the features of long-term disease remission in patients with rheumatoid arthritis (RA) on reduced treatment. The study concluded that disease activity, synovitis, rheumatoid factor and a history of smoking are associated with treatment failure.

Biological (b)DMARDs (disease-modifying anti-rheumatic drugs) are a type of treatment for RA. These therapies are associated with long-term adverse effects. Some clinicians recommend reducing the dose of bDMARDs if disease activity is low (remission). However, in some cases reducing bDMARDs can cause RA disease symptoms to worsen.

There may be clinical factors that indicate when a patient’s disease symptoms may worsen if they are on a tapered (reduced) bDMARD regimen. It is unclear what factors may predict the suitability of tapered bDMARD regimens in patients with RA.

This study included 77 patients with RA in remission. Patients were assigned to receive either a full dose or tapered dose regimen of bDMARDs over a 40-month period. At the beginning of the study patients underwent an assessment to measure disease activity, including a musculoskeletal ultrasound (MSUS). This assessment was repeated at 12 months, and at 3-monthly intervals thereafter until the end of the study.

57.1% of patients on the tapered bDMARD regimen did not maintain remission status throughout the study. Patients that failed the tapered bDMARD regimen had a longer disease duration and more severe disease activity prior to remission. Factors that may predict tapered bDMARD failure included the presence of synovitis (inflammation of fluid around joints), higher disease activity and the presence of rheumatoid factor (RF) in the joints. Smoking was also associated with a greater risk of failure at 12 months post-treatment.

The authors concluded that disease activity, synovitis, rheumatoid factor and a history of smoking are associated with treatment failure.

The number of patients included in this study was small. A larger study is needed to confirm these results.

If you have any concerns regarding rheumatoid arthritis treatment and remission, please discuss this with your physician.