Aspects of early arthritis. Definition of disease states in early arthritis: remission versus minimal disease activity

Abstract

With regard to rheumatoid arthritis, remission as currently used in the literature can have two meanings: either a state with persistent absence of clinical and radiological signs of disease activity without being treated for a specific time period, or it may point to a disease state with minimal disease activity during antirheumatic treatment. A risk factor for the first is absence of autoantibodies, with the anti-CCP-antibodies as best predictors, whereas risk factors for achieving a drug-induced state of minimal disease activity are not well defined. These definitions of remission refer to different disease states; therefore, we propose that the term remission is reserved for patients that are not treated with antirheumatic drugs.

Figure 1

Different clinical states that are indicated as remission in the current literature. The 'cure' state necessitates the absence of clinical evidence for arthritis and no progression of radiological damage during a specific time period without the use of disease modifying antirheumatic drugs. In the 'disease state with low disease activity' definition of remission, treatment with disease modifying antirheumatic drugs is allowed and this points to a disease state at the lower end of the continuum of disease activity and signifies that a patient is optimaly treated.

Figure 2

Multiple hit model for the development of rhematoid arthritis.