Clinical remission in rheumatoid arthritis. Data from the early arthritis cohort study CAPEA

Objective. To evaluate remission rates and therapeutic strategies in the routine care of early rheumatoid arthritis. Methods. Between 2010 and 2013, a total of 1,301 patients with early arthritis were followed by 89 rheumatologists for up to 2 years in an early arthritis cohort (CAPEA). Complete 2-year data are available for 669 patients with rheumatoid arthritis. Results. Ninety-three percent of patients were diagnosed with a moderate or high disease activity score (DAS28 > 3.2). Within 6 months, 40% were in clinical remission (DAS28 < 2.6) and 21% reached a low disease activity score (DAS28 > 2.6 to < 3.2). This proportion did not substantially increase during the 2-year follow-up. Methotrexate was the standard first-line treatment in 82% of patients. During follow-up, 10% were treated with a combination of disease-modifying antirheumatic drugs (DMARDs) and 12% with biological agents. In 60% of the patients who did not reach remission within 3 months (and 54% of patients without remission by 6 months), treatment was not changed. At the beginning, 77% of patients were treated with glucocorticoids at different starting doses (26% < 7.5 mg, 29% 7.5-20 mg, and 45% >= 20 mg of prednisolone per day). After 2 years, 47% remained on glucocorticoids. Conclusion. While 40% of patients achieved clinical remission through standard care within 6 months, disease activity remained moderate to high in 37% of patients at 2 years. In these patients a more consistent application of treatment may have increased the response rates.