NEW population-level data from England and Wales suggest that despite faster referral-to-treatment pathways, remission rates in early rheumatoid arthritis (RA) have remained stubbornly unchanged, revealing persistent inequities in care and delays earlier in the patient journey.
Using data from the National Early Inflammatory Arthritis Audit (NEIAA), researchers examined remission trends in people with newly diagnosed RA between May 2018 and April 2024. The study aimed to understand why improvements in service metrics, particularly time to treatment, have not translated into higher remission rates.
Stable National Rates, Uneven Local Outcomes
Among 21,904 individuals with RA in the audit, 13,752 had Disease Activity Score (DAS28) data available at 3 months following their first rheumatology assessment. Of these, just over one-third (34.6%) achieved remission, defined as a DAS28 score below 2.6.
National remission rates remained largely unchanged across the 6-year study period. However, beneath this apparent stability lay striking geographical variation. Regional remission rates ranged from 28.4% in London to 40.3% in the East of England, with up to threefold differences observed between individual hospitals within the same region. These findings point to substantial variation in how early RA care is delivered and optimised across services.
Who Is Less Likely to Reach Remission?
Multivariable analysis identified several patient- and system-level factors independently associated with lower odds of remission at 3 months. These included younger age, female sex, Black ethnicity, higher disease activity at presentation, delayed initiation of disease-modifying antirheumatic drugs (DMARDs), and longer symptom duration before specialist assessment.
Notably, while referral-to-treatment times have improved overall, delays between symptom onset and referral to rheumatology have increased since the COVID-19 pandemic. This suggests that barriers earlier in the care pathway, particularly at the level of primary care presentation, may be undermining the benefits of faster specialist management.
Beyond Referral Targets
The authors emphasise that focusing solely on referral-to-treatment metrics is unlikely to deliver further gains in remission rates. Instead, addressing delayed presentation, improving equity in access to high-quality care, and reducing unwarranted regional variation will be key to improving outcomes for people with early RA.
The study highlights a quiet paradox in modern rheumatology care: systems may be moving faster, but patients are not necessarily getting better sooner. To shift remission rates meaningfully, the authors conclude, policy and practice must look beyond speed and address the broader structural and social factors shaping the early RA journey.
Reference
Alveyn E et al. Trends in remission rates for rheumatoid arthritis in England and Wales: a population-level cohort study. Oxford Rheumatol. 2025;64(9):4957-67.
