Background Patients reaching remission for joint counts and CRP according to the ACR/EULAR Boolean definition fo remission (value<=1/10), but not remission for patient global assessment (PGA), are termed in ‘near-remission’(1). PGA may represent the wider impact of rheumatoid arthritis (RA) including psychological well-being and coping skills, rather than just the pathophysiological severity of the disease (2) and may include several concepts measured by the EULAR patient-derived RA Impact of Disease (RAID) score (3).
Objectives To assess whether psychological components of the RAID score explain the elevated PGA for patients in near-remission.
Methods The RAID database, based on an international multicenter cross-sectional study of consecutive RA patients from 12 European countries, was used (3). Each component of the RAID score ranges from 0 (no impact) to 10 (high impact). Patients in near-remission were compared to those in remission and not in remission for the proportion of patients with a score <=1/10, in each of the RAID components. Non-parametric comparisons were performed.
Results In total, 359 patients had complete data for this analysis: mean (±standard deviation) age 55.8±13.0 yrs, disease duration 12.6±10.5 yrs, 76.4% women. Mean RAID score was 4.3±2.2. With the ACR/EULAR Boolean definition, only 22 (6.1%) were in remission and 53 (14.8%) were in near-remission. In near-remission patients, the mean PGA was 3.3±1.5, and the mean RAID score was 3.6±1.8. The components of the RAID were mostly all >1/10 but specifically, physical well-being, fatigue, pain and functional assessment were more frequently >1/10 (94%, 89%, 87%, 83%) than sleep, coping or emotional well-being in these patients (79%, 79%, 74%, all p<0.05).
Conclusions The new definition of remission is extremely stringent and rarely attained for patients with long-standing RA. Near-remission is a more frequently achieved status. In this sample, psychological distress and lack of coping did not explain the raised PGA of near-remission, which was better explained by higher physical components of the RAID score. More work is needed to understand the patient perspective regarding remission.
Studenic P, et al. Ann Rheum Dis. 2012;71(10):1702-5.
Sanderson T, et al. J Rheumatol 2011;38;191-194.
Gossec L, et al. Ann Rheum Dis. 2011;70(6):935-42.
Disclosure of Interest None Declared