RESEARCH - Remission and RA: data on patients receiving usual care in twenty-four countries

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Arthritis Rheum. 2008 Sep;58(9):2642-51.

Remission and rheumatoid arthritis: Data on patients receiving usual

care in twenty-four countries.

Sokka T, Hetland ML, Mäkinen H, Kautiainen H, H¸rslev-sen K,

Luukkainen RK, Combe B, Badsha H, Drosos AA, Devlin J, Ferraccioli G,

Morelli A, Hoekstra M, Majdan M, Sadkiewicz S, Belmonte M, Holmqvist

AC, Choy E, Burmester GR, Tunc R, Dimiã A, Nedoviã J, Stankoviã A,

Bergman M, Toloza S, Pincus T; Questionnaires in Standard Monitoring

of Patients With Rheumatoid Arthritis Group.

Jyväskylä Central Hospital, Jyväskylä, Finland, and Medcare Oy,

Aänekoski, Finland.

OBJECTIVE: To compare the performance of different definitions of

remission in a large multinational cross-sectional cohort of patients

with rheumatoid arthritis (RA).

METHODS: The Questionnaires in Standard Monitoring of Patients with RA

(QUEST-RA) database, which (as of January 2008) included 5,848

patients receiving usual care at 67 sites in 24 countries, was used

for this study. Patients were clinically assessed by rheumatologists

and completed a 4-page self-report questionnaire. The database was

analyzed according to the following definitions of remission: American

College of Rheumatology (ACR) definition, Disease Activity Score in 28

joints (DAS28), Clinical Disease Activity Index (CDAI), clinical

remission assessed using 42 and 28 joints (Clin42 and Clin28), patient

self-report Routine Assessment of Patient Index Data 3 (RAPID3), and

physician report of no disease activity (MD remission).

RESULTS: The overall remission rate was lowest using the ACR

definition of remission (8.6%), followed by the Clin42 (10.6%), Clin28

(12.6%), CDAI (13.8%), MD remission (14.2%), and RAPID3 (14.3%); the

rate of remission was highest when remission was defined using the

DAS28 (19.6%). The difference between the highest and lowest remission

rates was >/=15% in 10 countries, 5-14% in 7 countries, and <5% in 7

countries (the latter of which had generally low remission rates

[<5.5%]). Regardless of the definition of remission, male sex, higher

education, shorter disease duration, smaller number of comorbidities,

and regular exercise were statistically significantly associated with

remission.

CONCLUSION: The use of different definitions of RA remission leads to

different results with regard to remission rates, with considerable

variation among countries and between sexes. Reported remission rates

in clinical trials and clinical studies have to be interpreted in

light of the definition of remission that has been used.

PMID: 18759292

http://www.ncbi.nlm.nih.gov/pubmed/18759292

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