The prevalence of clinical remission in RA patients treated with anti-TNF: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry
Rheumatology,

de Punder YMR et al. – Minimal disease activity (MDA) and DAS–28 <2.6 are reachable treatment targets in RA with anti–TNF, although residual disease activity might still be present. In turn, ACR/European League Against Rheumatism (EULAR) remission criteria leave little residual disease activity, but might be too stringent for use in daily clinical practice due to the strict cut–point in the patient–reported outcome.

Methods
  • In the Dutch Rheumatoid Arthritis Monitoring (DREAM) biologic registry the prevalence of DAS–28 <2.6, MDA and ACR/EULAR remission criteria was assessed.
  • Residual disease activity during MDA or remission was assessed as the percentage of patients with swollen and tender joints, elevated acute–phase reactants and general health on a visual analogue scale (VAS).
  • Disability was evaluated with the HAQ score.

Results
  • Prevalence of DAS–28 <2.6 was 27%, prevalence of MDA was 34% and ACR/EULAR remission was reached by 6% of patients.
  • Residual disease activity was present mostly in the most lenient criteria and occurred most frequently on the level of swollen joint count and VAS score: at least one swollen joint in DAS–28 <2.6, MDA and ACR/EULAR remission was present in, respectively, 51, 54 and 34% of the patients.
  • VAS >1 occurred in, respectively, 67, 69 and 0% of the patients.
  • Modification of the cut–point of the patient–reported outcome increased the prevalence of ACR/EULAR remission, but also the level of disability.

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