Early peripheral spondyloarthritis: a third drug-free at ten years

Design

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

Population

49 of 60 patients with very early peripheral spondyloarthritis

Primary outcome

Clinical and drug-free remission at 10 years

Effect

81.6% in remission; 30.6% drug-free; no psoriasis OR 9.1 (1.8-50)

CRESPA randomised 60 patients with peripheral spondyloarthritis and symptoms for 12 weeks or less to golimumab 50 mg monthly or placebo. This descriptive follow-up assessed 49 of them about ten and a half years later. Remission meant no swollen joints, enthesitis or dactylitis.

Forty of 49 (82%) were in clinical remission, and 15 (31%) had been in long-standing drug-free remission. Remission was not linked to age, sex, HLA-B27, or whether patients had originally received golimumab or placebo. Patients without psoriasis were much more likely to be drug-free (OR 9.1, 95% CI 1.8 to 50); almost half of non-psoriatic patients (13 of 27) were. Quality of life and function were better in those in remission.

The finding that initial allocation did not predict remission weakens any claim that early golimumab itself produced the long-term result. What the study does show is that very early peripheral spondyloarthritis, especially without psoriasis, often runs a favourable course, which matters when discussing treatment duration and tapering with patients.

• Tell patients with early peripheral spondyloarthritis that long-term remission is common, especially without psoriasis.
• Consider gradual withdrawal of therapy in sustained remission, with a clear plan to restart if needed.
• Expect psoriatic disease to need longer treatment; drug-free remission was much less frequent.
• Refer new peripheral spondyloarthritis early, while symptoms are only weeks old.

Why it matters

It supports trying treatment withdrawal in sustained remission rather than lifelong therapy for every patient.

Don't overread it

Initial golimumab allocation did not predict remission, so this does not show that early biologic treatment caused it.

The statistics, in plain English

The odds ratio of 9.1 has a very wide interval (1.8 to 50) because only 49 patients were assessed. The direction is clear, but the true size of the psoriasis effect is uncertain.

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