Remission of rheumatoid arthritis in clinical practice: Application of the ACR/EULAR 2011 remission criteria

Arthritis & Rheumatism, 07/18/2011

Shahouri SH et al. – Cross-sectional remission occurs at 5.0%-10.1%, with cumulative remission 2-3 times greater. Long-term remissions are rare. Problems with reliability and agreement limit criteria usefulness in the individual patient. The criteria can be an effective method for measuring clinical status and treatment effect in groups of patients in the community.

Methods

  • Examined remission in US Veterans Affairs RA (VARA) registry of 1,341 patients (91% men) with 9,700 visits and community rheumatology practice (ARCK) of 1,168 patients (28% men) with 6,362 visits
  • Studied cross-sectional and cumulative probabilities, agreement among various remission criteria, and aspects of reliability using Boolean definitions and CDAI and SDAI methods proposed by AE

Results

  • By AE definition for community practice (swollen and tender joints ≤1, patient global ≤1), cross-sectional remission was 7.5% (6.4, 8.7) for ARCK and 8.9% (7.9, 9.9) for VARA
  • Cumulative or remission at any observation was 18.0% (ARCK) and 24.4% (VARA) over a mean of 2.2 years
  • Addition of ESR or CRP to criteria reduced remission to 5.0-6.2%, and use of CDAI/SDAI increased proportions to 6.9-10.1%. 1.8%-4.6% of patients met remission criteria at ≥2 visits
  • Agreement between criteria definitions was good by Kappa and Jaccard measures
  • Among patients in remission, probability of remission lasting 2 years was 6.0%-14.1%
  • Among all patients the probability of remission lasting 2 years was <3%
  • Remission and examination results varied substantially among physicians by multilevel analyses

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