Trends in remission rates for rheumatoid arthritis in England and Wales: a population-level cohort study

Abstract

Objectives Considerable data support early treatment of rheumatoid arthritis (RA) to obtain disease remission. Data from the National Early Inflammatory Arthritis Audit (NEIAA) in England and Wales suggest that, despite recent improvements in referral-to-treatment times, remission rates remain unchanged. We investigated reasons for this disconnect by evaluating temporal trends, geographical variation, and predictors of remission in individuals with new RA diagnoses. Methods An observational cohort study of individuals with RA was conducted using data from NEIAA (May 2018 - April 2024). Temporal and geographical variation in remission rates (DAS28 < 2.6) were explored using interrupted time-series and case-mix-adjusted mixed-effects regression. Predictors of remission were assessed using multivariable logistic regression. Results 13 752 of 21 904 (62.8%) individuals with RA had data on DAS28 at 3 months after initial rheumatology assessment, of whom 4,764 (34.6%) achieved remission. National remission rates were stable from 2018 to 2024; however, wide geographical variation was observed, ranging from 28.4% (London) to 40.3% (East-of-England). Three-fold differences in remission rates were seen between individual hospitals within regions. Younger age, female sex, Black ethnicity, higher baseline DAS28, delayed DMARD initiation, and longer symptom duration were independently associated with reduced odds of remission. Delays between symptom-onset and referral have increased since the COVID-19 pandemic. Conclusion While national remission rates for early RA have remained stable in England and Wales since 2018, there is marked regional and hospital-level variation, highlighting ongoing inequities in service delivery. Addressing factors beyond referral-to-treatment time—particularly delayed presentation to primary care—is required to improve remission rates.