Background Failure to fulfill the patient global disease activity (PGA) score < 1 cm criterion in the 2010 ACR/EULAR remission criteria has been shown to be the major determinant of “near misses” of remission in established RA1. It is not known if this factor is of the same importance when RA patients are identified and treated at a very early stage.
Objectives To investigate the fulfillment of the Boolean version of the 2010 ACR/EULAR remission criteria after 2 years in patients with RA in a very early arthritis clinic, and to determine the major reasons for failing to fulfill these criteria.
Methods Patients with arthritis of <16 weeks’ duration were included in an early arthritis cohort from 2004-2010 and followed for 2 years with a comprehensive data collection. Patients were treated according to current clinical practice and not with a structured treat-to-target approach. Patients with RA according to the 2010 classification criteria with 2 years follow-up time were included in the present analysis. Frequency of 2-year remission was calculated, as well as which criterion was not fulfilled in patients fulfilling 3 Boolean criteria.
Results Of 1086 very early arthritis patients included, 185 (17.0 %) had RA according to the 2010 criteria at inclusion and had 2-year data on ACR/EULAR Boolean remission (mean (SD) age 52.5 (13.8) years, n (%) females 112 (60.5), median (25-75 percentile) duration of symptoms at inclusion 63 (40-83) days). After 2 years, 41/185 (22.2 %) were in Boolean remission, while 70/176 (39.8 %) were in SDAI remission (SDAI ≤3.3). 63 patients (34.5 %) fulfilled 3 of the Boolean criteria (criterion not fulfilled: PGA n=52, CRP n=5, TJC n=3, SJC n=1, missing data n=2) Omitting the PGA criterion, the remission rate was 93/185 (50.3 %). 44/52 (84.6 %) of patients with PGA > 1 had evaluator’s global disease activity (EGA) ≤ 1; 25 of these 44 (56.8 %) were in SDAI remission. 13 patients who were not in ACR/EULAR Boolean remission fulfilled the PGA criterion.
Conclusions Elevated PGA was the major reason for not being in remission after 2 years in patients with very early RA fulfilling 3 out of 4 of the Boolean remission criteria, and in the majority of these patients EGA was ≤ 1. Application of an index-based remission definition (SDAI) resulted in higher remission frequencies in patients with elevated PGA.
Studenic P, et al. Near misses for ACR/EULAR criteria for remission: effects of patient global assessment in Boolean and index-based definitions. Ann Rheum Dis 2012;71:1702-5.
Disclosure of Interest None Declared