Ten-year outcomes after treat-to-target therapy in early rheumatoid arthritis

The objective of this study is to examine 10-year clinical, structural and functional outcomes in patients with rheumatoid arthritis (RA) treated with an early treat-to-target strategy, and to examine whether achievement of sustained remission in early disease is associated with favourable long-term outcomes.

The ARCTIC (Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen) 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, and disease activity, radiographic damage, physical function, and survival were assessed. Patients were stratified according to achievement of sustained remission in ARCTIC and outcomes were compared between groups.

Of the 230 patients with ARCTIC, 218 (95%) were alive at 10 years and 179 (82%) participated in the follow-up study. Eighty-two per cent of patients were in Disease Activity Score (DAS) remission 10 years after diagnosis. Radiographic progression was limited, with a median (IQR) change in total van der Heijde modified Sharp score of 2.0 (0.5, 4.5) from baseline to 10 years. Physical function and health-related quality of life improved substantially, approaching population norms. Survival was comparable to that of the general population. Patients who achieved sustained DAS remission at 2 years had lower disease activity and higher physical function at the 10-year follow-up than those who did not.

In this cohort of patients treated according to an early treat-to-target strategy, clinical, structural, and functional outcomes remained favourable at 10 years. Achievement of sustained remission in early disease was associated with higher remission rates and better physical function at 10 years. These findings support current treatment recommendations.