medwireNews: People with rheumatoid arthritis (RA) who visit a rheumatologist within the first 6 weeks of experiencing symptoms are more likely to achieve sustained DMARD-free remission than those who wait for 7–12 weeks, suggest observational study results.
“This pivotal study confirms the importance of rapid referral clinics and immediate therapy,” say Paul Emery and Laurence Duquenne, both from the University of Leeds in the UK, in an editorial accompanying the research published in The Lancet Rheumatology.
The researchers used data from two cohorts – the Leiden Early Arthritis Clinic (EAC; 1996–2017) and the French ESPOIR study (2002–2005) – to evaluate the association between time to first rheumatology visit and long-term outcomes.
In the EAC cohort, rates of sustained DMARD-free remission (the absence of arthritis for at least 1 year after DMARD discontinuation) over a median 7.1 years of follow-up were 24% for the 127 patients who saw a rheumatologist within 6 weeks of symptom onset, compared with 20% for the 223 who saw a rheumatologist within 7–12 weeks and 15% for the 675 with a longer time between symptom onset and the first visit.
In a multivariable analysis, people who saw a rheumatologist within 6 weeks had a significant 59% higher probability of achieving sustained remission than those in the 7–12 weeks group and a significant 54% higher likelihood than those waiting for more than 12 weeks.
Ellis Niemantsverdriet, from Leiden University Medical Center in the Netherlands, and team say that a similar pattern of results was observed for the 514 patients in the ESPOIR cohort, with corresponding DMARD-free remission rates of 27%, 11%, and 10% during a median follow-up of 10 years, but the differences did not reach statistical significance on multivariable analysis.
The study authors then combined the data from both cohorts in a meta-analysis, finding that visiting a rheumatologist within 6 weeks was associated with a 69% and 67% higher likelihood of DMARD-free remission compared with visiting at 7–12 weeks and more than 12 weeks, respectively.
However, they observed comparable rates of radiographic progression among the different groups.
Therefore, “the decision about whether or not to try to implement the EULAR recommendation to see a rheumatologist within 6 weeks of symptom onset might depend on the long-term treatment aim,” write the researchers.
“Since clinically relevant joint destruction has become infrequent and sustained DMARD-free remission is increasingly achievable, achieving time to encounter within 6 weeks, although challenging, might become of increasing importance,” they add.
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Lancet Rheumatol 2020; doi:10.1016/S2665-9913(20)30061-8
Lancet Rheumatol 2020; doi:10.1016/S2665-9913(20)30103-X