The ACR/EULAR Boolean definition of remission in rheumatoid arthritis comprises maximal painful and swollen joint counts of 1, no acute phase reactants (maximum CRP 1 mg/dl), and a very low threshold for patient symptoms (maximal patient global assessment of 1 on a 0-10 scale).
This definition of remission is extremely stringent though it can more frequently be attained for patients with recent RA than for patients with long-standing disease.
Patients reaching remission for joint counts and CRP according to the ACR/EULAR Boolean definition of remission, but not remission for patient global assessment, are termed in ‘near-remission’. Near-remission seems to be twice as frequent as full remission, indicating many patients who have no objective signs of inflammation, do not regard their status as optimal.
This raises several questions: what explains the raised patient global assessmentin these patients without evident inflammation? Is it sub-clinical inflammation, or is it psychological distress? Is the cutoff value of 1/10 for patient global assessment too low, or is the phrasing of the patient global assessment question unclear? Indeed, patient global assessment may represent the wider impact of rheumatoid arthritis including psychological well-being and coping skills, rather than just the pathophysiological severity of the disease. And finally (and importantly for the clinician) should the management of patients in near-remission differ from the management of patients in full remission?
Disclosure of Interest None Declared