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  • Subclinical inflammation and joint damage progression in patients with early RA fulfilling 2011 vs 2022 ACR/EULAR Boolean remission criteria: data from the ARCTIC study

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Letter
Subclinical inflammation and joint damage progression in patients with early RA fulfilling 2011 vs 2022 ACR/EULAR Boolean remission criteria: data from the ARCTIC study
  1. Valeriia Melokhina1,
  2. Nina Paulshus Sundlisæter1,
  3. Joseph Sexton1,
  4. Ulf Sundin1,
  5. Anna-Birgitte Aga1,
  6. Kaja E Kjørholt1,2,
  7. Lena Bugge Nordberg1,
  8. Désirée van der Heijde1,3,
  9. Espen Haavardsholm1,2,
  10. Siri Lillegraven1
  1. 1 Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
  2. 2 Faculty of Medicine, University of Oslo, Oslo, Norway
  3. 3 Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  1. Correspondence to Dr Valeriia Melokhina, Center for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway; vmelekhina{at}gmail.com

https://doi.org/10.1136/ard-2023-224950

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    Remission has become an achievable goal for a large proportion of patients with rheumatoid arthritis (RA).1 In 2022, ACR and EULAR proposed a new version of their Boolean remission criteria, allowing patients to achieve remission with a higher level of patient global assessment (PGA). In the updated version, the threshold for PGA (0–10 cm) is 2 (Boolean 2.0), compared with the original threshold of 1 (Boolean 1.0).2 3 We aimed to investigate subclinical inflammation according to ultrasound and MRI, as well as radiographic progression, in patients with early RA fulfilling ACR/EULAR Boolean 2011 and 2022 remission criteria.

    The ARCTIC trial was a multicentre, open-label, randomised controlled strategy trial conducted in Norway. Patients were 18–75 years, fulfilled the 2010 ACR/EULAR classification criteria for RA, disease-modifying anti-rheumatic drug (DMARD) naïve and had an indication for DMARD therapy when included in the trial.4

    A structured ultrasound grey scale and power Doppler assessment of 32 joints, and evaluation of MRI synovitis, tenosynovitis, bone marrow oedema and MRI total inflammation score of dominant wrist and hand were performed at baseline, 12 and 24 months. At 12 and 24 months, patients were categorised as being in Boolean 1.0 remission or remission according to only Boolean 2.0 (ie, in Boolean 2.0 but not 1.0 remission). Linear mixed effect regression models were fit to ultrasound and MRI inflammation data, treating time as a categorical effect and with an indicator for whether a patient was in Boolean 1.0 or only 2.0 remission at the visit. Sensitivity analyses were done with log transformation of the MRI and ultrasound …

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    Footnotes

    • Handling editor Josef S Smolen

    • Prior conference presentation and published abstracts VM, NPS, JS, KK, LBN, US, EH and SL ‘Subclinical inflammation in early RA patients fulfilling 2011 vs 2022 ACR/EULAR Boolean remission criteria: data from the ARCTIC study’. 39th Scandinavian Congress of Rheumatology–Copenhagen, Denmark, 23–26 August 2023. Scandinavian Journal of Rheumatology. 2023;52(sup131):9–59 (Abstract number OP44) (Oral presentation, accepted 19 June 2023).

    • Contributors VM and SL designed the study, analysed data, interpreted data and wrote the report. JS performed the statistical analysis, interpreted data and wrote the report. NPS, JS, US, A-BA, KK, LBN, DvdH and EH designed the study, interpreted the data and reviewed the manuscript critically for important intellectual content. All authors have approved the final manuscript and vouch for the accuracy and completeness of the data and analyses.

    • Funding The Research Council of Norway and the Olav Thon Foundation.

    • Competing interests VM, JS, US, KK and LBN have nothing to disclose. SL and NPS report grants to the institution from The Research Council of Norway and from The South-Eastern Norway Regional Health Authority. A-BA reports personal fees from AbbVie, personal fees from Eli Lilly, personal fees from Novartis, personal fees from Pfizer, outside the submitted work. DvdH reports personal fees from AbbVie, personal fees from ArgenX, personal fees from Bayer, personal fees from BMS, personal fees from Galapagos, personal fees from Gilead, personal fees from Glaxo-Smith-Kline, personal fees from Janssen, personal fees from Lilly, personal fees from Novartis, personal fees from Pfizer, personal fees from Takeda, personal fees from UCB Pharma, outside the submitted work; and Director Imaging Rheumatology BV; DvdH is Associate editor of Annals of Rheumatic Diseases, Editorial board member of Journal of Rheumatology, Editorial board member of RMD Open, Advisor Assessment of Axial Spondyloarthritis international Society. EH reports grants to institution from The Research Council of Norway, grants to institution from The South-Eastern Norway Regional Health Authority; grants to institution from Norwegian Rheumatism Association; grants to institution from Olav Thon Foundation; investigator initiated research grants from AbbVie, UCB Pharma, Pfizer, MSD Norway, and Roche Norway; personal fees from Pfizer, personal fees from UCB, personal fees from AbbVie, personal fees from Boehringer-Ingelheim, personal fees from Lilly, personal fees from Gilead, personal fees from Novartis, outside the submitted work.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Ethical approval information, institution(s) and number(s) Regional Committee for Medical and Health Research Ethics South-East; reference number 2010/744.