12-05-2025
RA Remission Rates Vary in England and Wales
Although remission rates of patients with early rheumatoid arthritis (RA) remained stable between 2018 and 2024 in England and Wales, regional differences were noted. Factors influencing the achievement of remission at 3 months included sex, timing of conventional synthetic disease-modifying antirheumatic drug (csDMARD) initiation, and symptom duration before referral.
METHODOLOGY:
Researchers conducted an observational cohort study using data from a national audit programme including people from England and Wales to examine variations in RA remission rates and to explore the associated factors.
They included 21,904 patients with RA (mean age at diagnosis, 59.4 years; 63.6% women) who were enrolled in the programme between May 2018 and April 2024.
The primary outcome was the achievement of remission, defined as a disease activity score in 28 joints (DAS28) < 2.6 at 3 months after the initial assessment.
Data were available for analysis from 62.8% of patients at the 3-month mark.
TAKEAWAY:
Overall, 34.6% of patients achieved remission at 3 months, with stable remission rates observed throughout the study period. Remission rates at 3 months varied on the basis of the region, being lowest in London (28.4%) and highest in the East of England (40.3%) and South East England (40.0%).
Older age was associated with an increased likelihood of achieving remission at 3 months (adjusted odds ratio per 10-year increase in age, 1.06; P = .0007).
= .0007). Female sex, Black ethnicity, higher baseline DAS28, and delayed initiation of csDMARDs were independently associated with a decreased likelihood of achieving remission at 3 months ( P < .01 for all).
< .01 for all). Patients with longer symptom durations before referral to rheumatology services were less likely to achieve remission at 3 months, and the proportion of those patients with symptoms lasting for 6 months or more before referral increased after the COVID-19 pandemic ( P = .002).
IN PRACTICE:
"Importantly, a major impact of the pandemic has been increasing delays between symptom onset and presentation to primary care for individuals with RA, which needs to be addressed if remission rates are to be improved going forwards," the authors wrote.
SOURCE:
This study was led by Edward Alveyn, BMBCh, Centre for Rheumatic Diseases, King's College London, London, England. It was published online on May 05, 2025, in Rheumatology .
LIMITATIONS:
Additional factors influencing remission, such as the dosage of DMARDs and other medications, could not be captured. This study could not definitively determine the extent to which treatment delays affected the achievement of remission. Remission outcomes at different timepoints may not have been captured.
DISCLOSURES:
One author was supported by funding from the British Society for Rheumatology and another by a National Institute for Health and Care Research Clinical Lectureship. One author reported being an associate editor and another reported being a paid statistical reviewer for Rheumatology . Several authors reported receiving honoraria, grants, travel support, and/or advisory board fees from various pharmaceutical companies.
