Long-Term Outcomes in Seronegative Rheumatoid Arthritis.

Area of Science:

• Rheumatology
• Immunology
• Epidemiology

Background:

• Seronegative rheumatoid arthritis (RA) presents diagnostic challenges and variable disease trajectories.
• Understanding the long-term outcomes, including diagnosis evolution and remission potential, is crucial for patient management.

Purpose of the Study:

• To determine the 10-year cumulative incidence of diagnosis switching in seronegative RA.
• To assess the rates of drug-free remission and initiation of biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) in this population.

Main Methods:

• A cohort study of adult residents in Olmsted County, MN, with incident seronegative RA was conducted from 2005-2023.
• Manual chart review was used to collect data on diagnosis, treatment, and remission status.
• Statistical analysis included calculating 10-year cumulative incidence, adjusting for competing risks of death and diagnosis change.

Main Results:

• The 10-year cumulative incidence of a diagnosis change was 12.8%, with spondyloarthritis being the most common alternative diagnosis.
• The 10-year cumulative incidence of drug-free remission was 26.6%.
• The 10-year cumulative incidence of initiating a b/tsDMARD was 19.9%.

Conclusions:

• Around 13% of individuals initially diagnosed with seronegative RA experienced a change in diagnosis within a decade.
• Approximately 26.6% of patients with seronegative RA achieved drug-free remission over a 10-year period.
• These findings underscore the dynamic nature of seronegative RA and the potential for remission or need for advanced therapies.