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. 2012 Apr;71 Suppl 2(0 2):i86-8.
doi: 10.1136/annrheumdis-2011-200618.

Defining remission in rheumatoid arthritis

David Felson  1
Affiliations

Defining remission in rheumatoid arthritis

David Felson. Ann Rheum Dis. 2012 Apr.

Abstract

Objective: Given the inconsistency of remission definitions in rheumatoid arthritis (RA) trials, the goal of this American College of Rheumatology/European League Against Rheumatism committee was to define remission.

Methods: The committee instructed a working group that a new remission definition, among other requirements, needed to allow for little, if any, active clinical disease and to be defined using the core set of outcome measures for RA trials and that those in remission at one time needed to have a low risk of later worsening function or radiograph progression. Remission was to be defined using trial data for use in trials but needed to anticipate use in a practice setting.

Results: The working group started by evaluating the thresholds for core set measures compatible with remission and determined that patient-reported outcomes contributed importantly to the ability of outcome assessment to distinguish more from less effective treatments. The group created a candidate group of remission definitions to test, including Boolean versions and widely used indexes. Testing how well these candidate definitions predicted later good outcomes, the group found that Disease Activity Score 28 thresholds for remission performed worse than Simplified Disease Activity Index/Clinical Disease Activity Index or Boolean versions. Also, persons with low Disease Activity Score 28 occasionally had high joint counts, which were incompatible with remission. The parent committee chose two definitions: one Boolean (patient had to have all of the following: tender joint count, swollen joint count ≤ 1, C reactive protein ≤ 1 mg/dl) and patient global assessment ≤ 1 (on a 0-10 scale) and one Simplified Disease Activity Index ≤ 3.3.

Conclusion: The American College of Rheumatology/European League Against Rheumatism has promulgated two new similar definitions of remission for RA trials.

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Figures

Figure 1
Figure 1
Face validity: if you meet the remission definition, do you always have a low swollen joint count?
See this image and copyright information in PMC

References

    1. Felson DT, Smolen JS, Wells G, et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011;63:573–86. - PMC - PubMed
    1. Pinals RS, Masi AT, Larsen RA. Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum. 1981;24:1308–15. - PubMed
    1. Aletaha D, Ward MM, Machold KP, et al. Remission and active disease in rheumatoid arthritis: defining criteria for disease activity states. Arthritis Rheum. 2005;52:2625–36. - PubMed
    1. Koevoets R, Machado P, Bombardier C, et al. The value of conventional radiographs in undifferentiated arthritis: a systematic review. J Rheumatol Suppl. 2011;87:26–30. - PubMed
    1. Felson DT, Anderson JJ, Boers M, et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum. 1993;36:729–40. - PubMed

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