Background new EULAR/ACR rheumatoid arthritis (RA) criteria for the definition of clinical remission have recently been proposed and their effectiveness is still on debate.
Objectives to examine the performance of new EULAR/ACR RA remission criteria and the different progression of disability in patients with remission defined by Disease Activity Score (DAS)28-CRP or Simplified Disease Activity Index (SDAI), in a population of patients treated with anti-TNF agents in a set of clinical practice.
Methods our database includes 345 RA patients treated with TNF blockers between October 1999 and October 2011. The analysis was limited to those patients that had at least a 12-months follow-up and was performed retrospectively. DAS28-CRP, SDAI, and Health Assessment Questionnaire Disability Index (HAQ-DI) were collected at baseline and 12 months. The proportion of patients achieving SDAI clinical remission (<3.3) was compared with the one defined by DAS28-CRP(<2.6) using the chi-square test. One year HAQ-DI mean values in the two remission subgroups were compared using the Mann-Whitney test.
Results Out of 345 patients, 323 (177 infliximab, 56 etanercept, and 90 adalimumab) met the inclusion criteria of this study. The mean age was 54.7 years and the mean RA duration was 13.9 years. At 12 months, SDAI clinical remission was achieved by 11% and DAS28-CRP clinical remission by 25% of patients (p<0.0001). All 35 SDAI-remission patients were found in the DAS28-CRP group. In contrast, out of 82 DAS28-CRP-remission patients, 47 were not found in the SDAI-remission group. Twelve months mean HAQ-DI value was significantly lower in the SDAI-remission patients compared to the DAS28-CRP-remission group (0.171 vs 0.441, respectively; p=0.015).
Conclusions In a set of clinical practice, our data confirm that remission defined by SDAI is more stringent than the one defined by DAS28-CRP. Furthermore, the use of SDAI remission criteria as treatment target can be useful to better prevent disability in RA patients.
Felson DT, Smolen JS, Wells G, et al. American College of Rheumatology/European League Against Rheumatism Provisional Definition of Remission in Rheumatoid Arthritis for Clinical Trials. Arthritis Rheum 2011; 63 (3): 573-586.
Gülfe A, Aletaha D, Saxne T, et al. Disease activity level, remission and response in established rheumatoid arthritis: performance of various criteria sets in an observational cohort, treated with anti-TNF agents. BMC Muscoloskelet Dis 2009; 10: 41.
Disclosure of Interest None Declared