SMI-guided deep remission and TCM-assisted biologic De-intensification in rheumatoid arthritis: Yiqi-Jianpi-Tongluo combined with TNF-? inhibitors

Background: Achieving treatment targets in rheumatoid arthritis (RA) is feasible; however, safely tapering or discontinuing biologic agents remains challenging. Superb microvascular imaging (SMI) enables detection of subclinical synovitis, facilitating precise remission assessment. The Yiqi-Jianpi-Tongluo formula may help maintain disease stability, yet its role in combination with SMI-guided tapering is unclear. Objective: To evaluate whether SMI-guided deep remission effectively guides adalimumab (ADA) tapering and to assess the Yiqi-Jianpi-Tongluo formula in reducing recurrence risk during this process. Method: This retrospective study included 120 RA patients in clinical remission on stable ADA and methotrexate (January 2022–June 2024). Patients were stratified by baseline 28-joint SMI score (SMI=0 vs. SMI>0) and received either combined therapy (ADA reduced to 40mg/month + Yiqi-Jianpi-Tongluo formula) or Western therapy (ADA reduction alone). Methotrexate was continued. Primary endpoint was 12-month disease recurrence rate; secondary endpoints included ultrasound remission maintenance, traditional Chinese medicine (TCM) syndrome efficacy, inflammatory marker changes (CRP, IL-6, RF), and adverse events. Results: The combination group exhibited significantly lower 12-month recurrence rates (HR=0.368, 95% CI: 0.186–0.730, P=0.004), with consistent risk reduction across SMI strata. Baseline ultrasound remission was associated with significantly higher recurrence-free survival (HR=0.355, 95% CI: 0.179–0.702; P=0.004). The combination group also demonstrated superior ultrasound remission maintenance (90.32% vs. 69.23%, P=0.045) and TCM syndrome efficacy (80.33% vs. 54.24%, P=0.002), along with greater improvements in CRP, IL-6, and RF (all P<0.05). Adverse event rates were comparable (?²=0.128, P=0.721). Conclusion: SMI-guided deep remission effectively informs ADA tapering. Adding Yiqi-Jianpi-Tongluo formula significantly reduces recurrence risk, enhances remission maintenance, and improves symptoms without compromising safety, supporting an integrated strategy for RA remission management.