RESEARCH - Assessing remission in clinical practice

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Rheumatology Advance Access originally published online on March 6, 2007

Rheumatology 2007 46(6):975-979; doi:10.1093/rheumatology/kem007

Assessing remission in clinical practice

M. Mierau1, M. Schoels1, G. Gonda1, J. Fuchs1, D. Aletaha2 and J. S. Smolen1,2

12nd Department of Medicine – Centre for Rheumatic Diseases, Hietzing

Hospital and 2Department of Rheumatology, Internal Medicine III,

Medical University of Vienna, Vienna, Austria

Abstract

Objective. Remission constitutes the best achievable state in patients

zwith rheumatoid arthritis. We aimed at evaluating sustained remission

in a large cohort of patients followed prospectively in clinical

practice and to evaluate available instruments to define remission for

their stringency in defining this state.

Patients and Methods. We analysed remission and sustained remission in

621 patients who had two consecutive and complete clinical

observations; the average period between the two visits was 92 days

(median; quartiles: 82; 105). Remission was evaluated according to

modified ACR (mACR), 28 Joint Disease Activity Score (DAS28),

Simplified Disease Activity Index (SDAI) and Clinical Disease Activity

Index (CDAI) criteria. Sustained remission was defined as remission at

both consecutive visits. Patients were treated with traditional

disease- modifying antirheumatic drugs, mainly methotrexate, and

partly with biological agents (11%).

Results. Remissions at any one of the two visits were seen in 33.5% of

patients by SDAI or CDAI, 42.7% by DAS28, and 38.6% by mACR criteria

(P < 0.01). Sustained remission was observed in much lower proportions

of patients (between 16.7 and 19.6%, dependent on the instrument).

Agreement between classifications of remission by -statistics was very

good for SDAI vs CDAI, good for DAS28 vs SDAI or CDAI, and only

moderate for mACR vs the three other scores. Residual swollen joints

were observed in 15% of patients in DAS28 remission (range 1–9), 6% of

patients in mACR remission (range 1–8), but only 5% of patients in

CDAI or SDAI remission (range 1–2) (P < 0.01).

Conclusion. Sustained remission can be observed in 17–20% of patients

in clinical practice. CDAI and SDAI remission criteria are more

stringent than DAS28 and mACR criteria, since they allow for lesser

residual disease activity. Consequently, smaller proportions of

patients are classified as in remission by SDAI and CDAI than by DAS28

and mACR criteria. Sustained remission is an achievable goal in

clinical practice even with the most stringent of the definitions

studied.

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Read the full article here:

http://rheumatology.oxfordjournals.org/cgi/content/full/46/6/975

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