REMISSION has been shown to be common 10 years after treat-to-target therapy for early rheumatoid arthritis (RA), with 82% of patients in Disease Activity Score (DAS) remission and minimal structural damage, according to a new long-term follow-up study.
Treat-to-target therapy with early disease-modifying antirheumatic drug initiation has improved short- and medium-term outcomes in RA, with high remission rates and reduced radiographic progression. However, long-term data (≥10 years) from early RA cohorts treated to target remain scarce and are often limited by high attrition, heterogeneous strategies and older criteria, so it is unclear whether sustained remission in early disease is associated with favourable long-term outcomes.
The Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen (ARCTIC) trial enrolled 230 patients with early RA and applied a strict treat-to-target strategy for 2 years.
Participants were invited to a 10-year follow-up assessing disease activity, radiographic damage, physical function and survival. Patients were stratified according to achievement of sustained remission in ARCTIC, and outcomes were compared between groups.
Of the 230 patients, 218 (95%) were alive at 10 years and 179 (82%) participated in the follow-up study.
At 10 years, 82% of patients were in DAS remission. Radiographic progression was limited, with a small change in total van der Heijde modified Sharp score from baseline to 10 years (median change: 2.0; interquartile range: 0.5–4.5).
Physical function and health-related quality of life improved substantially, approaching population norms, and survival was comparable to that of the general population.
Patients who achieved sustained DAS remission at 2 years in ARCTIC had lower disease activity and higher physical function at 10 years than those who did not.
These findings have indicated that clinical, structural, and functional outcomes remain favourable 10 years after early treat-to-target therapy, and that achieving sustained remission in early disease is associated with higher remission rates and better physical function. The data support current treatment recommendations and emphasise the importance of achieving sustained remission early. As the study was observational, causality cannot be inferred, and confirmation in other cohorts is needed.
Reference
Nordberg LB et al. Ten-year outcomes after treat-to-target therapy in early rheumatoid arthritis. Annals of the Rheumatic Diseases. 2026;DOI:10.1016/j.ard.2026.09.003.
Featured image: Evrymmnt on Adobe Stock
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
