Very early rheumatoid arthritis is the major predictor of major outcome: clinical ACR remission and radiographic non-progression

OBJECTIVES: To identify predictors of clinical remission as well as of no x-ray
progression in a cohort of early rheumatoid arthritis (ERA) treated with a
tight-control protocol.
METHODS: A total of 121 consecutive patients with ERA were treated to reach
European League Against Rheumatism (EULAR) and/or American College of
Rheumatology (ACR) clinical remission with methotrexate (MTX) for 3 months, then
with a combination with anti-tumour necrosis factor if the patient did not
achieve a 44-joint Disease Activity Score (DAS44) ≤2.4. At baseline and after 12
months all the patients had hand and foot joint radiographs. Very early
rheumatoid arthritis (VERA) was defined as a disease with symptoms of less than
12 weeks.
RESULTS: In all, 46.3% of the patients reached DAS remission and 24.8% achieved
ACR remission. More than 60% of patients reached remission with MTX. Male sex and
an erythrocyte sedimentation rate <35 mm/h at onset arose as significant
predictors of EULAR remission, while VERA disease was the only predictor of ACR
remission. At baseline, 28.1% of the patients were erosive. Multivariate analysis
demonstrated that the only independent predictor of erosiveness was 'not having
VERA disease'. After 12 months, VERA was the only factor predicting a lack of new
erosions.
CONCLUSIONS: VERA represents the best therapeutic opportunity in clinical
practice to achieve a complete remission and to stop the erosive course of
rheumatoid arthritis.