Drug-Free Remission in Early Peripheral Spondyloarthritis, Including Psoriatic Arthritis: 10-Year Follow-Up From the CRESPA Trial

Objective: The aim of this study was to provide a descriptive analysis of the 10-year follow-up data from the Clinical Remission in Peripheral Spondyloarthritis (CRESPA) study. Here, patients fulfilling the Assessment of Spondyloarthritis International Society peripheral spondyloarthritis (pSpA) classification criteria, with symptom duration ≤12 weeks, were randomized to golimumab 50 mg every four weeks or placebo. Our aims were to assess the proportion of patients in (drug-free) clinical remission and identify baseline predictors of achieving (drug-free) remission at 10-year follow-up. Methods: All patients from the original CRESPA study were invited for a standardized evaluation 10 years after inclusion. Clinical remission was defined as the absence of swollen joints, enthesitis, or dactylitis. Results: Of 60 original patients, 49 were evaluated after a mean (±SD) of 10.5 (±0.87) years. Of the patients, 81.6% (40 of 49) were in clinical remission, of whom 30.6% (15 of 49) achieved longstanding drug-free remission. Remission was not linked to baseline characteristics like sex, age, HLA-B27 positivity, psoriasis, or initial treatment allocation. Patients without psoriasis at baseline were significantly more likely to achieve drug-free remission (odds ratio 9.1, 95% confidence interval 1.8–50), with 48.1% patients with nonpsoriatic pSpA (13 of 27) remaining in drug-free remission. Health-related quality of life and physical function were significantly better in patients in remission. Conclusion: Remission induction with golimumab in patients with early pSpA enables achievement of sustained clinical remission in the majority of patients, with one-third of patients attaining drug-free remission. Strikingly, almost half of patients with nonpsoriatic pSpA remained in drug-free remission. These findings strongly suggest that early, intensive treatment has the potential to achieve long-term disease control, potentially leading to sustained drug-free remission in a subset of patients.