A real-world observational study found that patients with rheumatoid arthritis who achieved clinical deep remission — defined as no tender or swollen joints with normal inflammatory markers — were more likely to maintain sustained remission over 5 years and appeared less vulnerable to relapse during treatment tapering than patients who met standard DAS28-CRP remission criteria alone. At 5 years, sustained remission rates were 63% in the clinical deep remission group vs 38% in the nonclinical deep remission group.