Radiological damage in patients with rheumatoid arthritis on sustained remission

Objective: To assess the radiological damage progression in patients with recent rheumatoid arthritis in sustained remission. Methods: A cohort of 191 patients with active early (< 1 year) rheumatoid arthritis was prospectively assessed at baseline, 3 and 5 years by the Disease Activity Score (DAS) and the Sharp-van der Heijde Score (SHS) for radiographic damage. Patients in remission (DAS < 1.6) at the 3-year and 5-year time points were compared with patients with a persistently active rheumatoid arthritis by Wilcoxon's signed rank test. Results: 57 patients died, were lost to follow-up or had incomplete data; 30 (15.7% of those who completed) patients were in remission at 3 and 5 years. The SHS in these two groups was not significantly different at baseline (p=0.15), but was lower in the remission group at 5 years (p=0.0047). The median (IQR) radiographic score increased from 0.5 (0-7) at baseline to 2.5 (0-14) after 5 years for the remission group (p=0.18) and from 2 (0-7) to 13 (3-29) in the group with active rheumatoid arthritis (p < 0.001). 5 (16.7%) patients in remission had relevant progression of radiographic damage (ie, progression > 4.1 points) and 6 (20%) presented new erosions in a previously unaffected joint between the third and the fifth years. Conclusion: Patients with early rheumatoid arthritis in sustained remission did not present statistically significant radiographic degradation at the group level; nevertheless, 16.7% of these patients did present degradation. Absence of progression should be part of the remission definition in rheumatoid arthritis.