Early Diagnosis Linked to Likelihood of Remission in One Year

Very early rheumatoid arthritis as a predictor of remission: a multicentre real life prospective study, Gremese et al 2012

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What did they study?

This study, conducted in Italy, evaluated the percentage of patients that experienced remission of rheumatoid arthritis symptoms after one year of treatment. Patients referred to the study, which required the presence of two or more swollen joints, were broken down into two groups, depending on whether their symptoms were present for more or less than 12 weeks. Those patients with symptoms lasting less than 12 weeks were referred to as VERA, or very early rheumatoid arthritis.

All patients were started on 15 mg/week of methotrexate (or up to 25 mg/week) for three months. Following that three month period, patients were treated according to their individual doctor's plan, with the option of adding another non-biologic DMARD or a biologic TNF-alpha blocker like Enteracept (AKA, Enbrel).

After 12 months of treatment, patients were assessed for the number of swollen and tender joints, erythrocyte sedimentation rate, C-reactive protein levels in their blood, duration of morning stiffness, self-reported assessment of pain and health, and HAQ disability index.

What were the results?

After 12 months of treatment, 34.3% of patients achieved remission as defined by DAS-28 score of <2.6 and 15.2% achieved remission as defined by the American College of Rheumatology, which is a stricter standard.

Of those patients that achieved remission, statistical analyses showed that the most likely predictive factor was treatment with DMARD within three months of symptoms appearing. 

Interestingly, at the end of the 12 month period, patients with VERA were generally only on a non-biologic DMARD. Only 9.5% of those patients were on a TNF-alpha blocker. In comparison, 25.6% patients who enrolled on the study with symptoms lasting longer than three months were on a TNF-alpha blocker. Furthermore, of those patients in remission, only 10% of VERA patients received a TNF-alpha blocker, but 32% of non-VERA patients had.

What does this mean?

This study demonstrates the importance of early diagnosis and treatment in patients. In the paper, the investigators discussed educating the population about rheumatoid arthritis and its symptoms to encourage potential patients to seek medical attention early on. They also stressed education of primary care physicians in recognizing the symptoms and referring patients to the care of a rheumatology specialist early.

It is important to inform and educate the public about rheumatoid arthritis. It is easy to, as I did, talk yourself out of taking your pain and other symptoms seriously. As shown in this study, a delayed diagnosis is very much related to staying in pain and becoming disabled. Since this is a disease that first affects people in the prime of their lives, early treatment is especially vital to avoid losing productive years.