Re-examining remission definitions in rheumatoid arthritis: considering the 28-Joint Disease Activity Score, C-reactive protein level and patient global assessment

Abstract

The Editors of the 5 journals of the American College of Rheumatology and European Alliance of Associations for Rheumatology have been reminded by this editorial that ACR and EULAR have jointly agreed on various classification criteria, definitions, recommendations, or points to consider, which do not always find reflection in manuscripts submitted to the journals. Consequently, in the future, the Editors will enforce the use of the products obtained in the course of joint ACR/EULAR or EULAR/ACR activities in all respective papers. For rheumatoid arthritis this would mean use of the ACR/EULAR or EULAR/ACR classification criteria, remission definitions, recommendations on what to report in clinical trials, and others, as pertinent. The same applies to other diseases. There are valid and important reasons that these activities have been undertaken by ACR and EULAR, and therefore, the conclusions of the various task forces, which have been endorsed by ACR and EULAR, should be respected by investigators and study administrators. This does not mean other methods could not be used in a study, but at the least, the reports should address the methods agreed on by the two organisations. Maintaining uniformity across major publications regarding rheumatoid arthritis remission or other definitions not only allows for more appropriate comparison across analyses, but also enhances readers’ ability to interpret results. Author instructions across the five journals will more strongly reflect this requirement.

Keywords: arthritis; autoimmune diseases; rehabilitation; rheumatoid.

FIGURE 1

The contribution of each component of the 28-joint disease activity score using the C-reactive protein level (DAS28-CRP) to remission (score <2.6 (solid horizontal line)) when other components are in the range of remission. Red dotted line represents TJC = 0 and blue dotted line represents TJC = 1. The DAS28-CRP is composed of 4 components: CRP level (A), tender joint count (TJC) (B), swollen joint count (SJC) (C), and patient global assessment of arthritis activity (D). in each graph, it is assumed that the three components other than the one depicted met the threshold for remission (CRP 0.5, TJC 0 (red dashed lines) or 1 (blue dashed lines), SJC 0, patient global assessment 1). Note that when the TJC is 0, most values of CRP and patient global assessment yield a DAS28 of <2.6 (‘remission’), and SJC <10 yields DAS28 ‘remission’.