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Extended report
Remission and radiographic outcome in rheumatoid arthritis: application of the 2011 ACR/EULAR remission criteria in an observational cohort
  1. Siri Lillegraven1,2,
  2. Femke HM Prince1,
  3. Nancy A Shadick1,
  4. Vivian P Bykerk1,
  5. Bing Lu1,
  6. Michelle L Frits1,
  7. Christine K Iannaccone1,
  8. Tore K Kvien2,
  9. Espen A Haavardsholm2,
  10. Michael E Weinblatt1,
  11. Daniel H Solomon1
  1. 1Division of Rheumatology, Brigham and Women's Hospital/Harvard Medical School, Boston, Maryland, USA
  2. 2Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  1. Correspondence to Siri Lillegraven, Division of Rheumatology/Section of Clinical Sciences, Alumnae Hall – Room 305, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; siri.lillegraven{at}


Objectives One goal of remission in rheumatoid arthritis (RA) is to halt joint damage. The authors assessed the progression of radiographic joint damage among RA patients in remission by the new ACR/EULAR criteria (Boolean approach) compared with remission thresholds for the simplified disease activity index (SDAI), clinical disease activity index (CDAI) and disease activity score based on 28 joints and C-reactive protein (DAS28-CRP) in an observational cohort, and evaluated the relationship between time in remission and radiographic joint damage.

Methods 535 RA patients underwent physical examination and laboratory assessment at baseline, 1 and 2 years. Radiographs at baseline and 2 years were scored by the van der Heijde modified Sharp score (TSS). Positive likelihood ratios for a good radiographic outcome (change in TSS <1 unit/year) were calculated for each of the remission criteria. Radiographic progression was compared between patients in remission at none, one, two and three visits by χ2 goodness of fit statistics.

Results 20% of patients in ACR/EULAR remission at baseline had radiographic progression, 24% in SDAI remission, 19% in CDAI remission and 30% of patients in DAS28–CRP remission. The positive likelihood ratio for good radiographic outcome was 2.6 for ACR/EULAR criteria, 2.1 for SDAI, 2.8 for CDAI and.1.5 for DAS28–CRP. Reduced radiographic progression was observed for patients with an increasing number of visits in remission (p<0.003 for all criteria, χ2 goodness of fit statistics).

Conclusions Patients with RA in remission by any established criteria can experience radiographic progression. An increased number of visits in remission was associated with reduced radiographic damage.

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board, Brigham and Women's Hospital.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.