Determinants of reaching drug-free remission in patients with early rheumatoid or undifferentiated arthritis after one year of remission-steered treatment

Rheumatology (Oxford). 2015 Aug;54(8):1380-4. doi: 10.1093/rheumatology/keu477. Epub 2015 Feb 15.


Objective: The aim of this study was to assess whether baseline characteristics in patients with undifferentiated arthritis or early RA affect the possibility of achieving drug-free remission after 1 year (DFR1 year) of early remission induction therapy.

Methods: We included 375 patients participating in the IMPROVED study who achieved remission (DAS < 1.6) after 4 months (early remission) and were by protocol able to achieve DFR1 year. Having started with MTX plus prednisone, patients tapered prednisone to zero; after 8 months, those still in remission tapered MTX to zero, while those not in remission restarted prednisone. Characteristics of patients achieving and not achieving DFR1 year were compared. Logistic regression was performed to identify predictors of DFR1 year.

Results: After 1 year, 119 patients (32%) were in DFR. Presence of RF, fulfilling the 2010 criteria for RA, and a low tender joint count were associated with achieving DFR1 year, whereas presence of ACPA was not. None of the baseline characteristics was independently associated with DFR1 year. DFR1 year was sustained for 4 months in 65% of the patients. ACPA-positive patients less often had sustained DFR than ACPA-negative patients (58% vs 80%, P = 0.013).

Conclusion: After 1 year of remission-steered treatment, 32% of the patients who had achieved early remission after 4 months were able to taper medication and achieved DFR. Neither the presence of ACPA nor any other baseline characteristics were independently associated with achieving DFR1 year, but in ACPA-positive patients DFR was less often sustained.

Keywords: anti-citrullinated protein antibodies (ACPAs); drug-free remission; early arthritis; predictors; rheumatoid arthritis (RA).

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Anti-Idiotypic / blood
  • Antirheumatic Agents / therapeutic use*
  • Arthritis / drug therapy*
  • Arthritis / immunology*
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / immunology*
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • Peptides, Cyclic / immunology
  • Prednisone / therapeutic use
  • Remission Induction
  • Remission, Spontaneous*
  • Treatment Outcome


  • Antibodies, Anti-Idiotypic
  • Antirheumatic Agents
  • Peptides, Cyclic
  • cyclic citrullinated peptide
  • Prednisone
  • Methotrexate