Background Treatment target in rheumatoid arthritis (RA) is remission or low disease activity. Considering that there is no quantitative “gold standard “ for measuring the disease activity, monitoring and evaluation of RA patients is made through composite scores, which have an important subjective component. Moreover, the laboratory investigations used (ESR and CRP) are commonly discordant with the clinical findings
Objectives To evaluate disease activity and establish relations between disease activity scores and their components in RA patients
Methods We performed a transversal study which included 447 RA patients (aged 18 to 86-years-old) admitted to our Rheumatology Department between January 2014 and December 2015. Patients' evaluation was performed by the rheumatologist. All the data obtained from the medical history, clinical examination, laboratory tests and imaging studies was recorded at the same date. All patients signed a dated informed consent at the time of admission.
Results The study included 447 patients, mean age 62.13±11.44, 85% women, accounting for a female:male ratio (F:M) of almost 6:1 (5.7:1) with an average disease duration of 10,75±8,85 years. 48% of our patients presented with normal CRP values (≤0.5mg/dl) and values of ≤1mg/dl for CRP, compatible with Boolean remission, were present in 66.6% of the patients. A significant percentage of our sample population (194 patients: 43.4%) registered normal ESR values (≤28 mm/h)
Remission and LDA were registered in 18.1% up to 29.8%.of the patients, depanding on the score used. The lowest rate of remission and low activity is registered through the DAS28 ESR evaluation (18.1%). The other three scores outline similar percentages for T2T group of patients: 27.1% (SDAI), 28.7% (CDAI), and 29.7% (DAS28 CRP). The LDA group is characterized in our study by a small number of swollen joints (<1), medium-normal ESR values (<30mm/h) and CRP values <1mg/dl (with the exception of SDAI). Consequently, patients with low activity based on the afore mentioned scores meet remission according to Boolean definition.
Conclusions The disease activity and implicitly the remission rate are appreciated differently depending on the scale used. The limit between remission and low disease activity is fragile, influenced mainly by the purely subjective components of the assessment instruments. The important differences between the subjective and objective components of the evaluation scales recommend the supplementation of methods used in order to emphasize the real degree of joint inflammation.
Jonathan Kay, Olga Morgacheva, Daniel E Furst et al. Clinical disease activity and acute phase reactant levels are discordant among patients with active rheumatoid arthritis: acute phase reactant levels contribute separately to predicting outcome at one year. Arthritis Research & Therapy 2014, 16:R40.
Tuulikki Sokka et al. Remission and Rheumatoid Arthritis. Data on Patients Receiving Usual Care in Twenty-Four Countries. ARTHRITIS & RHEUMATISM Vol. 58, No. 9, September 2008, pp 2642–2651.
Glenn Haugeberg et al. Ten years of change in clinical disease status and treatment in rheumatoid arthritis: results based on standardized monitoring of patients in an ordinary outpatient clinic in southern Norway. Arthritis Research & Therapy (2015) 17:219.
Disclosure of Interest None declared