EN PL
REVIEW PAPER
Drug-free remission: the goal of the future in management of patients with rheumatoid arthritis
 
More details
Hide details
 
Online publication date: 2017-12-30
 
 
Reumatologia 2017;55(6):284-289
 
KEYWORDS
ABSTRACT
Management of patients with rheumatoid arthritis according to the “treat-to-target” strategy requires achievement of remission or low disease activity when remission cannot be achieved (mostly in patients with advanced disease). The assessment of remission and low disease activity is based on a number of definitions depending on the applied instruments which do not always correspond to one another.
The role of biomarkers and imaging techniques (ultrasound and magnetic resonance imaging) in predicting the risk for disease relapse after achieving remission and tapering disease-modifying antirheumatic drugs treatment are presented. The concept of achieving the full control of inflammation including residua synovial inflammation and drug free-remission is discussed.
 
REFERENCES (39)
1.
Smolen JS Aletaha D, Bijlsma JW, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 2010; 69: 631-637.
 
2.
Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2014; 73: 493-509.
 
3.
Smolen JS, Landewe R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update Ann Rheum Dis 2017; 76: 960-977.
 
4.
Filipowicz-Sosnowska A. Reumatoidalne zapalenie stawów. In: Interna Szczeklika. Gajewski P (red.). Medycyna Praktycz-.
 
5.
na, Kraków 2017; 1958-1973.
 
6.
Kucharz EJ. Reumatoidalne zapalenie stawów. In: Wielka interna. Puszczewicz MJ (ed.), Medical Tribune, Warszawa 2016; 75-88.
 
7.
Prevoo ML, van’t Hof MA, Kuper HH, et al. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995; 38: 44-48.
 
8.
Smolen JS, Breedveld FC, Schiff MH, et al. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology (Oxford) 2003; 42: 244-257.
 
9.
Aletaha D, Nell VP, Stamm T, et al. Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther 2005; 7: 796-806.
 
10.
Felson DT, Smolen JS, Wells G, et al. American College of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann Rheum Dis 2011; 70: 404-413.
 
11.
Inove E, Yamanaka H, Hara M, et al. comparison of disease activity score (DAS) 28- erythrocyte sedimentation rate and DAS28-C-reactive protein threshold values. Ann Rheum Dis 2007; 66: 407-409.
 
12.
Castrejón I, Ortiz AM, Toledano O, et al. Estimated cutoff points for the 28-joint disease activity score based on C-reactive protein in a longitudinal register of early arthritis.
 
13.
J Rheumatol 2010; 37: 1439-1443.
 
14.
Prince FH, Bykerk VP, Shadick NA, et al. Sustained rheumatoid arthritis remission is uncommon in clinical practice. Arthritis Res Ther 2012; 14: (R68) 1-8.
 
15.
Balsa A, Del Amo J, Blanco F, et al. Prediction of functional impairment and remission in rheumatoid arthritis patients by biochemical variables and genetic polymorphisms. Rheumatology (Oxford) 2010; 49: 458-466.
 
16.
Aletaha D, Alasti F, Smolen JS. Optimization of a treat-to-target approach in rheumatoid arthritis: strategies for the 3-month time point. Ann Rheum Dis 2016; 75: 1479-1485.
 
17.
Mack ME, Hsia E, Aletaha D, et al. Comparative assessment of the different American College of Rheumatology/European League Against Rheumatism remission definitions for rheumatoid arthritis for their use as clinical trial end points. Arthritis Rheum 2017; 69: 518-528.
 
18.
Nam JL, Ramiro S, Gaujoux-Viala C, et al. Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 2014; 73: 1331-1339.
 
19.
Liu Y, Hazlewood GS, Gilaan G, et al. Impact of obesity on remission and disease activity in rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Care Res 2017; 69: 157-165.
 
20.
Smolen JS, Landewe R, Bijlsma W, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2017; 76: 960-977.
 
21.
Singh JA, Saag KG, Bridges SL, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res 2016; 68: 1-25.
 
22.
Khawaja MN, Bergman MJ, Yourish J, et al. Routine Assessment of patient Index Data 3 and the American College of Rheumatology/European League Against Rheumatism Provisional Remission Definitions as predictors of radiographic outcome in a rheumatoid arthritis clinical trial with tocilizumab. Arthritis Care Res 2017; 69: 609-615.
 
23.
Fraenkel L, Miller AS, Clayton K, et al. When patients write the guidelines: patient panel recommendations for the treatment of rheumatoid arthritis. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Care Res 2016; 68: 26-35.
 
24.
Smolen JS, Kremer JM, Gaich CL, et al. Patient-reported outcomes from a randomized phase III study of baricitinib in patients with rheumatoid arthritis and an inadequate response to biological agents (RA-BEACON). Ann Rheum Dis 2017; 79: 694-700.
 
25.
Radner H, Smolen JS, Aletaha D, et al. Remission in rheumatoid arthritis: benefit over low disease activity in patient-reported outcomes and costs. Arthritis Res Ther 2014; 16: R56.
 
26.
Brown AK, Conaghan PG, Karim Z, et al. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008; 58: 2958-2967.
 
27.
Brown AK, Quinn MA, Karim Z, et al. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: Evidence from an imaging study may explain structural progression. Arthritis Rheum 2006; 54: 3761-3773.
 
28.
Gandjbakhch F, Conaghan PG, Ejbjerg B, et al. Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state. J Rheumatol 2011; 38: 2039-2044.
 
29.
Naredo E, Valor L, De la Torre I, et al. Predictive value of Doppler ultrasound-detected synovitis in relation to failed tapering of biologic therapy in patients with rheumatoid arthritis. Rheumatology 2015; 54: 1408-1414.
 
30.
Alivernini S, Peluso G, Fedele AL, et al. Tapering and discontinuation of TNF- blockers without disease relapse using ultrasonography as a tool to identify patients with rheumatoid arthritis in clinical and histological remission. Arthritis Res Ther 2016; 18: 39-43.
 
31.
Nordberg LB, Lie E, Lillegraven S, et al. Ultrasonography versus clinical examination in early DMARD-naive rheumatoid arthritis – a comparative study on the individual joint level. Arthritis Rheum 2015; 67 (Suppl. 10): 162 (abstract).
 
32.
Terslev L, Torp-Pedersen S, Qvistgaard E, et al. Doppler ultrasound findings in healthy wrists and finger joints. Ann Rheum Dis 2004; 63: 644-648.
 
33.
Haschka J, Englbrecht M, Hueber AJ, et al. Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping anti-rheumatic therapy: interim results from the prospective randomized controlled RETRO study. Ann Rheum Dis 2016; 75: 45-51.
 
34.
Van den Broek M, Klarenbeek NB, Dirven L, et al. Discontinuation of infliximab and potential predictors of persistent low disease activity in patients with early rheumatoid arthritis and disease activity score-steered therapy: subanalysis of the BeSt study. Ann Rheum Dis 2011; 70: 1389-1394.
 
35.
Detert J, Bastian H, Listing J, et al. Induction therapy with adalimumab plus methotrexate for 24 weeks followed by methotrexate monotherapy up to week 48 versus methotrexate therapy alone for DMARD-naïve patients with early rheumatoid arthritis: HIT HARD, an investigator-initiated study. Ann Rheum Dis 2013; 72: 844-850.
 
36.
Lamers-Karnebeek FBG, Jacobs H, Fransen J, et al. The Poet-Us Study: Can ultrasonography predict flare in patients with RA and persistent low disease activity in whom the TNF inhibitor is stopped? Preliminary results of an ongoing study. Ann Rheum Dis 2013; 72: A214.
 
37.
Tanaka Y, Hirata S, Kubo S, et al. Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study. Ann Rheum Dis 2015; 74: 389-395.
 
38.
Rech J, Hueber AJ, Finzel S, et al. Prediction of disease relapses by multibiomarker disease activity and autoantibody status in patients with rheumatoid arthritis on tapering DMARD treatment. Ann Rheum Dis 2016; 75: 1637-1644.
 
39.
Schett G, Emery P, Tanaka Y, et al. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann Rheum Dis 2016; 75: 1428-1437.
 
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
eISSN:2084-9834
ISSN:0034-6233
Journals System - logo
Scroll to top