3 Key Takeaways
Plain English Summary- 01Core Finding
We then validated each threshold by evaluating clinical characteristics and prognosis (radiographic progression, cardiovascular disease, and death) among those defined as RALI, comparing its performance to traditional clinical remission using descriptive statistics and Cox regression.
- 02Study Evidence
Tested in a observational cohort study (n = 960) at the real-world cohort stage.
- 03Practical Meaning
Observational cohort findings reveal real-world links, though lifestyle or unmeasured factors cannot be fully ruled out without an RCT.
What This Means for You
More patients achieved RALI than traditional remission with similar or lower rates of radiographic progression as well as low rates of high-risk characteristics and adverse long-term outcomes. These results support RALI as a point-of-care clinical target to inform management.
The Discovery
This study aims to define and validate a state of rheumatoid arthritis low inflammatory activity (RALI) based on previously validated modified disease activity scores, a tool aimed at improving precision of management. We used data from 3 clinical trials (N = 960) and a large real-world study (Veterans Affairs Rheumatoid Arthritis [VARA] Registry; N = 3423). We determined the optimal discriminatory cutoff using receiver-operating-characteristic analyses for each modified score compared with traditional remission at month 6 in a large clinical trial. We then validated each threshold by evaluating clinical characteristics and prognosis (radiographic progression, cardiovascular disease, and death) among those defined as RALI, comparing its performance to traditional clinical remission using descriptive statistics and Cox regression. Thresholds for RALI for the Modified Disease Activity Score in 28 Joints (M-DAS28), the Modified Simplified Disease Activity Index, and the Modified Clinical Disease Activity Index were determined to be <1.4, ≤3, and ≤2, respectively. In 3 datasets, a greater number were in RALI compared with the number in remission by traditional scores. RALI was similarly predictive of radiographic progression compared with remission defined by traditional scores. In VARA, M-DAS28 RALI was more common than DAS28 remission (a clinically meaningful level vs 32.1%). Those in RALI but with high traditional scores had higher rates of comorbidity (eg, anxiety and depression) and lower rates of seropositivity and erosive disease. RALI was a stronger predictor of cardiovascular disease and death than traditional scores.
How It Works, Simply
This immunology research focuses on inflammation. Researchers evaluated it using an observational cohort study (N = 960) at the real-world cohort stage of medical research.
3 Key Takeaways
Clinical Takeaways- 01Core Finding
We then validated each threshold by evaluating clinical characteristics and prognosis (radiographic progression, cardiovascular disease, and death) among those defined as RALI, comparing its performance to traditional clinical remission using descriptive statistics and Cox regression.
- 02Study Evidence
Tested in a observational cohort study (n = 960) at the real-world cohort stage.
- 03Practical Meaning
Observational cohort findings reveal real-world links, though lifestyle or unmeasured factors cannot be fully ruled out without an RCT.
Key Numbers
Biological Mechanism & Study Design
Study Design & Cohort
Observational cohort study
Observational cohort study (N = 960) · Real-World Cohort
Biological Pathway & Modality
Inflammation
Intervention: Validation of rheumatoid arthritis low inflammatory activity: a novel clinical
Experimental Findings & Endpoints
This study aims to define and validate a state of rheumatoid arthritis low inflammatory activity (RALI) based on previously validated modified disease activity scores, a tool aimed at improving precision of management.
We used data from 3 clinical trials (N = 960) and a large real-world study (Veterans Affairs Rheumatoid Arthritis [VARA] Registry; N = 3423). We determined the optimal discriminatory cutoff using receiver-operating-characteristic analyses for each modified score compared with traditional remission at month 6 in a large clinical trial.
We then validated each threshold by evaluating clinical characteristics and prognosis (radiographic progression, cardiovascular disease, and death) among those defined as RALI, comparing its performance to traditional clinical remission using descriptive statistics and Cox regression. Thresholds for RALI for the Modified Disease Activity Score in 28 Joints (M-DAS28), the Modified Simplified Disease Activity Index, and the Modified Clinical Disease Activity Index were determined to be <1.4, ≤3, and ≤2, respectively.
In 3 datasets, a greater number were in RALI compared with the number in remission by traditional scores. RALI was similarly predictive of radiographic progression compared with remission defined by traditional scores.
In VARA, M-DAS28 RALI was more common than DAS28 remission (a clinically meaningful level vs 32.1%). Those in RALI but with high traditional scores had higher rates of comorbidity (eg, anxiety and depression) and lower rates of seropositivity and erosive disease.
RALI was a stronger predictor of cardiovascular disease and death than traditional scores.
Clinical Translation & Practice Context
More patients achieved RALI than traditional remission with similar or lower rates of radiographic progression as well as low rates of high-risk characteristics and adverse long-term outcomes.
These results support RALI as a point-of-care clinical target to inform management.
The Bottom Line · Clinical Pearl
“More patients achieved RALI than traditional remission with similar or lower rates of radiographic progression as well as low rates of high-risk characteristics and adverse long-term outcomes.”
Published in Annals of the Rheumatic Diseases · Current Stage: Real-World Cohort
