Clinical and ultrasound remission at 48 weeks of upadacitinib in rheumatoid arthritis: real-world results from the Italian multicenter UPARAREMUS study

Background: Achieving clinical remission is a key therapeutic goal in rheumatoid arthritis (RA). While pivotal trials and early real-world studies have demonstrated the efficacy of upadacitinib (UPA), data on its impact as assessed by imaging remain limited. Here, we report the 48 weeks outcomes from the full cohort of the UPARAREMUS study. Methods: UPARAREMUS is a 12-month follow-up, observational study involving RA patients from 9 Italian rheumatology centers initiating UPA. The primary objective was to evaluate the proportion of patients achieving combined clinical and ultrasound (US) remission. Secondary endpoints included the proportion of patients achieving clinical or US remission alone at multiple time points. Results: A total of 115 patients were enrolled. Combined clinical and US remission was achieved in 35% of patients at week 12, increasing to 55% at week 24 and 72% at week 48. Younger age, lower baseline CDAI, and higher ESR were associated with higher remission rates, while baseline corticosteroid use was linked to a 65% lower likelihood of achieving remission. More than 60% of patients showed absence of power Doppler (PD) signal at week 24, rising to over 80% by week 48. The majority of patients in clinical remission also achieved US remission. Conclusions: After 12 months of UPA treatment, a substantial proportion of RA patients achieved combined clinical and US remission, independent of prior bDMARDs use or monotherapy. These findings highlight UPA's ability to induce and maintain deep disease control in real-world practice.