“ Lower CLEE adversely affects longitudinal changes in disease activity and PROs and is associated with a lower likelihood of achieving clinical remission in RA. Diabetes (11.3% vs 8.7%; P =.031)) and osteoporosis (57.1% vs 46.8%; P =.001) were also more common among the lower CLEE group. Over the 5-year follow-up, both groups showed improvements, but disease activity, functional disability, and QOL remained significantly worse among the lower CLEE group. Stratification by CLEE quartiles revealed a dose-response pattern, with higher CLEE associated with progressively better outcomes. “Lower CLEE adversely affects longitudinal changes in disease activity and PROs and is associated with a lower likelihood of achieving clinical remission in RA,” the study authors concluded.