RESEARCH - Remission in RA: physician and patient perspectiives

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J Rheumatol. 2009 Mar 30.

Remission in Rheumatoid Arthritis: Physician and Patient Perspectives.

Wolfe F, Boers M, Felson D, Michaud K, Wells GA.

From the National Data Bank for Rheumatic Diseases and University of

Kansas School of Medicine, Wichita, Kansas; Boston University School

of Medicine, Boston, Massachusetts; University of Nebraska School of

Medicine, Omaha, Nebraska, USA; Department of Clinical Epidemiology

and Biostatistics, VU University Medical Centre, Amsterdam, The

Netherlands; and University of Ottawa, Ottawa, Ontario, Canada.

OBJECTIVE: To examine the prevalence of remission in rheumatoid

arthritis (RA) as determined by physicians and patients independently,

and to determine the degree of agreement among methods, the strength

of predictor variables of remission, and the length of remission.

METHODS: Eight hundred patients with RA completed a remission

questionnaire on the day of their rheumatologist visit and their

rheumatologists completed a separate questionnaire the same day. The

question(s) were: " Given all your experience with disease activity in

RA, are you [is your patient] currently in remission? " . Patients also

completed 0-10 visual analog scales for RA activity, pain, and

functional limitation.

RESULTS: The percentage of patients in remission by physician and

patient assessment was 34.8% [95% confidence interval (CI) 31.4-38.2]

and 30.9% (95% CI 27.7-34.20), respectively. The percentage of

patients classified concordantly (full agreement) was 78.6%, and the

associated kappa statistic was 0.54 (95% CI 0.45-0.58). The median

duration of remission was 2.0 years. The median RA activity, pain, and

functional scores were 1.0, 1.5, and 1.25 for patient-determined

remission and 1.5, 1.5, and 1.5 for physician-determined remission.

CONCLUSION: Physician and patient estimates of remission in RA are

similar (34.8% to 30.9%), and agreement was 78.6% (kappa 0.53). Based

on previous data and the observed presence of disease activity, this

definition of remission appears to be a measure of minimal disease

activity rather than true remission. The problem of remission rates

will not be solved until a consensus definition that has relevance in

research and the clinic is developed.

PMID: 19332634

http://www.ncbi.nlm.nih.gov/pubmed/19332634

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