At 60 months , 4 evident clinical features of treatment failure were defined : area under curve ( AUC ) between 6-60 months for disease activity score assessing 28 joints > 2.6 ; AUC 6-60 for health assessment questionnaire > 0.5 ; progression in total Sharp/van der Heijde score 0-60 months > 3 units ; and need of PRD or biologic DMARD treatment at 60 months .