In RA, becoming seronegative over the first year of treatment does not translate to better chances of drug-free remission

In rheumatoid arthritis (RA), it is becoming common to attempt to taper or stop medication, aiming for sustained drug-free remission (SDFR). Autoantibody seropositivity is a poor prognostic factor for this treatment goal. However, autoantibody levels may change and patients may become seronegative, sometimes termed ‘immunological remission’.1 Understanding how often this occurs and whether it is favourable for achieving SDFR is important to determine whether becoming seronegative is a meaningful prognostic marker for drug tapering decisions. Furthermore, it will elucidate pathways that lead to long-term resolution of the pathophysiology underlying RA. To that end, we investigated the relationship between seroconversion and SDFR. In baseline and 1-year serum of 381 patients with seropositive RA, we measured 14 RA-associated autoantibodies by ELISA2: anti-CCP2 IgG, IgM and IgA; rheumatoid factor IgM and IgA; anti-CarP IgG, IgM and IgA; anti-acetylated lysine vimentin IgG and anti-acetylated ornithine vimentin IgG (Orgentec Diagnostika , Germany); and anti-citrullinated vimentin 59–74 IgG, anti-citrullinated fibrinogen β 36–52 and α 27–43 IgG, anti-citrullinated enolase 5–20 IgG. Patients originated from the IMPROVED study,3 a randomised controlled treat-to-target trial …