Early peripheral SpA: sustained remission for most, drug-free remission for a third

Design

Ten-year follow-up of a randomised placebo-controlled trial (descriptive)

Population

49 of 60 patients with early peripheral spondyloarthritis (symptoms ≤12 weeks)

Primary outcome

Clinical and drug-free remission at about 10 years

Effect

Remission 81.6%; drug-free 30.6%; without psoriasis 48.1%, OR 9.1 (1.8–50)

CRESPA randomised 60 patients with peripheral spondyloarthritis and symptoms for 12 weeks or less to golimumab or placebo. This ten-year follow-up, published in Arthritis & Rheumatology on 21 September, reassessed 49 of them after a mean of 10.5 years.

Of these, 81.6% were in clinical remission, with no swollen joints, enthesitis or dactylitis, and 30.6% had been in longstanding remission without drugs. Patients without psoriasis at the start were far more likely to be in drug-free remission (48.1%, OR 9.1). Remission was not linked to age, sex, HLA-B27 or original treatment allocation. Quality of life and function were better in those in remission.

The analysis is descriptive, and since remission did not depend on randomised arm, it cannot credit golimumab specifically. What it does show is that very early peripheral spondyloarthritis can stay quiet for a decade, often off treatment. That supports early referral and, in sustained remission, a careful attempt at tapering, particularly in patients without psoriasis.

• Refer suspected peripheral spondyloarthritis early; this cohort was treated within 12 weeks of onset.
• In sustained remission, consider a monitored attempt to taper treatment.
• Expect better drug-free outcomes in patients without psoriasis.
• Assess swollen joints, enthesitis and dactylitis at each review to define remission.
• Tell patients that long-term remission is a realistic goal.

Why it matters

Many patients with early peripheral SpA may not need lifelong treatment.

Don't overread it

A descriptive follow-up of 49 patients; remission did not depend on the randomised treatment.

The statistics, in plain English

An odds ratio of 9.1 with an interval from 1.8 to 50 means patients without psoriasis had much higher odds of drug-free remission, but the very wide interval reflects small numbers; the true effect could be modest or very large.

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