Evidence for Predictive Validity of Remission on Long-Term Outcome in Rheumatoid Arthritis: A Systematic Review

Objective. Remission is rapidly becoming a key end point in rheumatoid arthritis (RA) clinical trials, but its definition is not satisfactory. Although it is generally believed that achieving a state of remission will lead to better structural outcome, this has not been studied systematically. As part of an undertaking to redefine remission, the current review describes the relationship between remission and long-term structural outcome. Methods. A systematic literature search of PubMed, EMBase, and The Cochrane Library intersected 3 groups of terms: RA, remission, and long-term outcome. The search identified 1,138 records, of which 14 were relevant to the research question. Results. All of the studies included in this review showed a relationship between remission and long-term structural damage or disability. Patients that achieved a state of remission, defined in various ways, showed less deterioration of function and radiographic progression compared with patients who did not reach a state of remission. Conclusion. Patients who achieved a state of remission were less likely to show deterioration of function and radiographic progression compared with patients who did not reach a state of remission.