{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:59:42Z","timestamp":1793145582622,"version":"4.5.0"},"reference-count":27,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["92374202"],"award-info":[{"award-number":["92374202"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"crossref","award":["2022YFC3602000"],"award-info":[{"award-number":["2022YFC3602000"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,3,20]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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%\u2009CI 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%\u2009CI 5.01 to 14.32, p&lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-006387","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:50:14Z","timestamp":1777042214000},"page":"e006387","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Sustaining remission in rheumatoid arthritis: the role of clinical deep remission and its implications for drug tapering"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0274-3996","authenticated-orcid":false,"given":"Haihui","family":"Li","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Peking University People\u2019s Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Peking University People\u2019s Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9146-3753","authenticated-orcid":false,"given":"Huaqun","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Peking University People\u2019s Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Peking University People\u2019s Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianping","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Peking University People\u2019s Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Peking University People\u2019s Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ru","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Peking University People\u2019s Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"2026042407500873000_12.2.e006387.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.123919"},{"key":"2026042407500873000_12.2.e006387.2","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1002\/art.43199","article-title":"Three-year results of tapering tumor necrosis factor inhibitor to withdrawal compared to stable tumor necrosis factor inhibitor among patients with rheumatoid arthritis in sustained remission: a multicenter randomized trial","volume":"77","author":"Kj\u00f8rholt","year":"2025","journal-title":"Arthritis Rheumatol"},{"key":"2026042407500873000_12.2.e006387.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.4542"},{"key":"2026042407500873000_12.2.e006387.4","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1093\/rheumatology\/key054","article-title":"Prevalence of sustained remission in rheumatoid arthritis: impact of criteria sets and disease duration, a nationwide study in Sweden","volume":"58","author":"Einarsson","year":"2019","journal-title":"Rheumatology (Oxford)"},{"key":"2026042407500873000_12.2.e006387.5","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keg072"},{"key":"2026042407500873000_12.2.e006387.6","doi-asserted-by":"publisher","DOI":"10.1186\/ar1740"},{"key":"2026042407500873000_12.2.e006387.7","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1002\/art.39945","article-title":"Comparative assessment of the different American College of Rheumatology\/European League Against Rheumatism Remission Definitions for Rheumatoid Arthritis for their use as clinical trial end points","volume":"69","author":"Mack","year":"2017","journal-title":"Arthritis Rheumatol"},{"key":"2026042407500873000_12.2.e006387.8","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1097\/CM9.0000000000000227","article-title":"Clinical deep remission and related factors in a large cohort of patients with rheumatoid arthritis","volume":"132","author":"Liu","year":"2019","journal-title":"Chin Med J (Engl)"},{"key":"2026042407500873000_12.2.e006387.9","article-title":"Clinical remission of rheumatoid arthritis in a multicenter real-world study in Asia-Pacific region","volume":"15","author":"Sun","year":"2021","journal-title":"Lancet Reg Health West Pac"},{"key":"2026042407500873000_12.2.e006387.10","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2007.084459"},{"key":"2026042407500873000_12.2.e006387.11","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223356"},{"key":"2026042407500873000_12.2.e006387.12","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1002\/art.42507","article-title":"2022 American College of Rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis","volume":"75","author":"England","year":"2023","journal-title":"Arthritis Rheumatol"},{"key":"2026042407500873000_12.2.e006387.13","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.13513"},{"key":"2026042407500873000_12.2.e006387.14","doi-asserted-by":"crossref","first-page":"iv8","DOI":"10.1093\/rheumatology\/kead430","article-title":"A real-world 2-year prospective study of medication tapering in patients with well-controlled rheumatoid arthritis within the rheumatoid arthritis medication tapering (RHEUMTAP) cohort","volume":"62","author":"Tageldin","year":"2023","journal-title":"Rheumatology (Oxford)"},{"key":"2026042407500873000_12.2.e006387.15","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2024-004444","article-title":"Agreement between patient-reported flares and clinically significant flare status in patients with rheumatoid arthritis in sustained remission: data from the ARCTIC REWIND trials","volume":"10","author":"Holten","year":"2024","journal-title":"RMD Open"},{"key":"2026042407500873000_12.2.e006387.16","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2023-224476"},{"key":"2026042407500873000_12.2.e006387.17","doi-asserted-by":"crossref","DOI":"10.7326\/J23-0095","article-title":"In RA in remission for >1 y, tapering TNFi to discontinuation did not meet noninferiority criteria compared with stable TNFi for disease flare at 12 mo","volume":"176","author":"Lafita","year":"2023","journal-title":"Ann Intern Med"},{"key":"2026042407500873000_12.2.e006387.18","doi-asserted-by":"crossref","first-page":"e767","DOI":"10.1016\/S2665-9913(21)00220-4","article-title":"Treatment tapering and stopping in patients with rheumatoid arthritis in stable remission (RETRO): a multicentre, randomised, controlled, open-label, phase 3 trial","volume":"3","author":"Tascilar","year":"2021","journal-title":"Lancet Rheumatol"},{"key":"2026042407500873000_12.2.e006387.19","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.141520"},{"key":"2026042407500873000_12.2.e006387.20","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209201"},{"key":"2026042407500873000_12.2.e006387.21","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-019-1937-4","article-title":"The effect of deep or sustained remission on maintenance of remission after dose reduction or withdrawal of etanercept in patients with rheumatoid arthritis","volume":"21","author":"Tanaka","year":"2019","journal-title":"Arthritis Res Ther"},{"key":"2026042407500873000_12.2.e006387.22","doi-asserted-by":"crossref","unstructured":"Norvang V , Brinkmann GH , Yoshida K , et al . Achievement of remission in two early rheumatoid arthritis cohorts implementing different treat-to-target strategies. Arthritis Rheumatol 2020. doi:10.1002\/art.41232","DOI":"10.1002\/art.41232"},{"key":"2026042407500873000_12.2.e006387.23","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-217246"},{"key":"2026042407500873000_12.2.e006387.24","doi-asserted-by":"crossref","DOI":"10.1186\/ar4315","article-title":"Discontinuation of adalimumab after attaining disease activity score 28-erythrocyte sedimentation rate remission in patients with rheumatoid arthritis (HONOR study): an observational study","volume":"15","author":"Hirata","year":"2013","journal-title":"Arthritis Res Ther"},{"key":"2026042407500873000_12.2.e006387.25","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-208941"},{"key":"2026042407500873000_12.2.e006387.26","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.21362"},{"key":"2026042407500873000_12.2.e006387.27","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1002\/rai2.12171","article-title":"Artificial intelligence in rheumatoid arthritis","volume":"5","author":"Sun","year":"2025","journal-title":"Rheumatol Autoimmun"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2025-006387","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:50:18Z","timestamp":1777042218000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2025-006387"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4,24]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/rmdopen-2025-006387"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2025-006387","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}