Rheumatoid arthritis
ORIGINAL RESEARCH Sustaining remission in rheumatoid arthritis: the role of clinical deep remission and its implications for drug tapering
Haihui Li , Mengyan Zhou, Huaqun Zhu , Chun Li, Jianping Guo, Yuan Jia, Ru Li
To cite: Li H, Zhou M, Zhu H, et al . Sustaining remission in rheumatoid arthritis: the role of clinical deep remission and its implications for drug tapering. RMD Open 2026; 12 :e006387. doi:10.1136/ rmdopen-2025-006387
ABSTRACT Objective While sustained remission is the treatment goal for rheumatoid arthritis (RA), its long-term remission remains challenging. This real-world study aimed to assess the role of clinical deep remission (CliDR) in sustained remission and the risk of relapse, as well as its interaction with drug tapering. Methods Of the 541 patients enrolled in the cohort, 145 who achieved a Disease Activity Score in 28 joints using C reactive protein (CRP) remission with 5 years of follow-up after remission were included in this study. Participants were stratified by CliDR status (defined as no tender/ swollen joints with normal CRP/erythrocyte sedimentation rate). Kaplan-Meier analysis was used to compare sustained remission rates. Multivariable Cox regression with time-dependent covariates was performed to identify independent predictors and to assess the interaction between CliDR and drug tapering. Results The sustained remission rate declined over time but was significantly higher in the CliDR group (62.5%; 95% CI 45.3% to 77.1%) than the non-CliDR group (38.1%; 95% CI 29.6% to 47.3%) at 5 years (p=0.014). In the non-CliDR group, tapering was associated with an 8.47-fold increase in the hazard of relapse (HR=8.47, 95% CI 5.01 to 14.32, p<0.001). The interaction between group and tapering was statistically significant (HR=0.26, 95% CI 0.07 to 0.98, p=0.046), indicating that the effect of tapering on relapse risk was significantly attenuated in the CliDR group compared with the non-CliDR group. Conclusions Our findings suggest that achieving CliDR is associated with significantly higher sustained remission rates in RA and that the safety of treatment tapering is contingent on prior achievement of CliDR. INTRODUCTION Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterised by erosive polyarthritis. The treatment strategy aims to minimise long-term joint structural damage and preserve physical function in patients with RA, with the primary objective of achieving sustained clinical remission. 1 The
sustained remission rate of RA remains low, especially during the drug tapering process. Even if patients have maintained remission for over a year, there is still a high recurrence rate. 2 3 Residual joint inflammation is a critical obstacle to patients maintaining long-term remission. 4 The definition of remission in RA is clinically challenging, as different remission criteria allow for varying degrees of inflammation. The Simpli- fied Disease Activity Index (SDAI) is the sum of five components: 28-joint tender joint count (TJC28), 28-joint swollen joint count (SJC28), patient global assessment (0–10 cm), physician global assessment (0–10 cm) and C reactive protein (CRP) ⇒ These findings support the integration of CliDR as- sessment into routine clinical practice, which may guide more personalised and safer treatment de- escalation strategies. The results could also inform future guidelines on remission maintenance and drug reduction in RA. WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Achieving sustained remission is a key treatment goal in rheumatoid arthritis (RA), but it remains unclear whether clinical deep remission (CliDR) in- fluences sustained disease control and successful drug reduction. WHAT THIS STUDY ADDS ⇒ This study demonstrates that patients with RA who achieve CliDR are significantly more likely to main- tain sustained remission and are less prone to flare during drug tapering. CliDR was associated with a lower risk of relapse, independent of conventional risk factors. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
HL and MZ contributed equally.
Received 25 September 2025 Accepted 20 March 2026
Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Peking University People’s Hospital, Beijing, China permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. © Author(s) (or their employer(s)) 2026. Re-use
Correspondence to Professor Ru Li; liru@pkuph.edu.cn
Professor Yuan Jia; jiayuan1023@sina.com
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Li H, et al . RMD Open 2026; 12 :e006387. doi:10.1136/rmdopen-2025-006387
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