Reaching remission was only part of the story
More than half of the 200 adults in the cohort reached the study's remission threshold at least once. The researchers counted 117 patients, or 58.5%, in that group, while 83 patients, or 41.5%, never achieved remission.
Remission was defined using ASDAS, the study's disease-activity score: a value below 1.3 counted as remission. To count as sustained remission, that threshold had to be met for at least six consecutive months.
The results separated reaching remission from keeping it. Fifty-one patients, or 43.6%, achieved sustained remission for at least six months, while 102, or 87.2%, lost remission status at least once.
Remission did not arrive on a single schedule. Among patients who reached it, 44, or 37.6%, did so within the first year, 20, or 17.1%, in the second year, 13, or 11.1%, in the third year, and 40, or 34.2%, after three years. The reported average time to first remission was 37.7 months.
The numbers came from routine care
The researchers set out to measure remission rates and associated factors in a real-life, treat-to-target setting. The cohort consisted of adults with radiographic or non-radiographic axial spondyloarthritis treated at a German tertiary-care center, in a nonclinical-trial setting. Eligibility required at least two prior hospital visits, and people with difficulty communicating in German were excluded.
The 200 patients were recruited consecutively between March and September 2022. The analysis drew on 3,093 ASDAS values from 3,158 documented visits; 65 values, or 2.1%, were unavailable because CRP was missing.
Associations, not answers about cause
The analysis looked for factors associated with remission using multivariable logistic regression, a method that examines several factors together. Higher CRP levels were associated with increased odds of remission, with an odds ratio of 1.35 and an interval of 1.10 to 1.73. Lower BASDAI scores were also associated with increased odds, with an odds ratio of 0.72 and an interval of 0.53 to 0.97. These are associations from an observational analysis, not evidence that either measure caused remission.
The study also found different observed rates by diagnostic pathway. Outside-diagnosis patients had a 57% remission rate at six months, compared with 34% among in-house-diagnosis patients. At 12 months, the rates were 39% and 17%, respectively. Because the comparison was observational, it cannot establish that the diagnostic pathway caused the difference.
Why the findings need caution
Taken together, the findings suggest that remission can be reached in routine care but may be difficult to maintain for many patients in this cohort. The timing data also show that first remission was not confined to the first year, with 34.2% of first remissions occurring after three years. The study describes patterns of remission; it does not show that a particular treatment caused them.
The authors identify the single specialized tertiary center as a source of selection bias and limited generalizability. The study therefore describes this center's cohort, rather than establishing that the same remission rates would appear in other settings.
The study received ethics approval, obtained written informed consent from all participants, and followed the Declaration of Helsinki.
Novartis funded part of the data collection, and the authors declared no competing interests. The article was accepted after full peer review, but this version has not yet undergone final copyediting, proofreading, and typesetting.
Paper data and sources
Original title: Remission Rates of Patients With Axial Spondyloarthritis in a Tertiary Care Center.
Authors: Franziska Kluempers, Imke Redeker, Abin P Puravath et al.
Journal/Repository: The Journal of rheumatology
Status: Peer-reviewed
First online: 2026-10-15
DOI: 10.3899/jrheum.2025-1143
Original paper · Full text