Ten-year follow-up data from a small Belgian trial suggest that starting biologic therapy soon after a diagnosis of peripheral spondyloarthritis can lead to lasting remission without ongoing disease-modifying drugs. The study, published in Arthritis & Rheumatology, tracked 49 of the original 60 participants from the CRESPA trial, which randomized patients with newly diagnosed disease to six months of the TNF inhibitor golimumab or placebo. At year 10, 15 patients were in clinical remission with no DMARD use, while 25 were in remission but still taking DMARDs and nine had active disease.
The strongest predictor of drug-free remission was the absence of psoriasis. Among patients without psoriasis at baseline or during follow-up, 48% achieved drug-free remission at 10 years, compared with just 13% of those with psoriasis. The researchers found no other baseline factors that predicted success. They argued that the results support a "window of opportunity" for early intervention, with implications for clinical practice and healthcare costs.
Other outcomes were also favorable: nearly two-thirds of the 49 patients reported no mobility problems or difficulties with daily activities, and over 40% were pain-free. However, the study has notable limitations, including its small, single-center design and the fact that 15 of 20 placebo patients switched to active therapy early in the trial, leaving no true control group for long-term comparison.