Does immunological remission, defined as disappearance of autoantibodies, occur with current treatment strategies? A long-term follow-up study in rheumatoid arthritis patients who achieved sustained DMARD-free status

What is it about?

Currently, the best possible outcome of patients with rheumatoid arthritis is sustained DMARD-free remission, which is defined as sustained absence of synovitis after cessation of all DMARD-therapy. Absence of anti-citrullinated protein antibodies (ACPA) at disease presentation is an important predictor of achievement of this outcome, however also a subgroup of ACPA-positive patients is able to achieve sustained DMARD-free remission. Previously, it was suggested that seropositive patients with immunological remission during follow-up, defined as disappearance of ACPA and RF have the highest chance of achieving sustained DMARD-free remission. However, in our longitudinal study, where we measured anti-CCP2 IgG, IgM and RF IgM levels at diagnosis, before and after achievement of remission of patients who achieved sustained DMARD-free remission during follow-up and patients with persistent RA, we observed similar seroreversion rates in patients with and without achievement of remission. Thus, sustained DMARD-free status in autoantibody-positive RA was not paralleled by an increased frequency of reversion to autoantibody-negativity. This form of immunological remission should therefore not be a treatment target.

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