Early remission is associated with improved survival in patients with inflammatory polyarthritis: results from the Norfolk Arthritis Register. Issue 9 (7th June 2013)

• Record Type: Journal Article
• Authors: Scirè, Carlo A; Lunt, Mark; Marshall, Tarnya; Symmons, Deborah P M; Verstappen, Suzanne M M
• Is Part Of: Annals of the rheumatic diseases. Volume 73:Issue 9(2014)
• Page Start: 1677
• Page End: 1682
• Publication Date: 2013-06-07
• Subjects: Early Rheumatoid Arthritis -- Epidemiology -- Disease Activity -- Arthritis; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2013-203339
• Languages: English
• ISSNs: 0003-4967

Abstract

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.