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Abstract
Background Remission has become the realistic goal in rheumatoid arthritis (RA) with the advent of new therapy including biologic agents. In 2011 ACR/EULAR has developed new definition of remission in RA which can presumably reflect the residual disease activity more accurately. However there is little information regarding the validity and the feasibility of the new definition in clinical practice.
Objectives To clarify the performance of ACR/EULAR remission criteria we investigated the prevalence and agreement between remission definitions at KIC (Keio Immunotherapy Center) cohort where RA patients were treated with biologic agents.
Methods RA patients who were treated with biologic agents available in Japan for more than two months at KIC as of April 2011 were cross-sectionally included in this analysis. Remission rates were calculated based on 4 definitions: DAS28<2.6, SDAI≤3.3, CDAI≤2.8 and ACR/EULAR (Boolean-based) which requires the complete fulfillment of the follwings; TJC≤1 SJC≤1, patient global (PtGH) ≤1 on a 10cm VAS scale and CRP ≤1mg/dl. It was also examined which variable was more attributed the cause of not-fulfillment of Boolean-based to.
Results A total of 319 subjects were analyzed; 85% were female, mean (SD) age was 56 (14) years old and mean disease duration was 124 (114) months and mean treatment duration with the current biologic agents was 18 (17) months. Most were RF positive (76%) and anti-CCP antibody positive (72%). One hundred twenty three patients were treated with infliximab, 86 with etanercept, 30 with adalimumab, 66 with tocilizumab and 17 with abatacept. Remission was identified in 56% using DAS28, 47% by SDAI, 43% by CDAI, 33% by Boolean-based. The mean (max) swollen joint count in remission patients was 0.55 (5) by DAS28, 0.23 (2) by SDAI, 0.19 (2) by CDAI, and 0.17 (1) by Boolean-based. When three variables in Boolean-based were ≤1, the other variable was PtGH in 77%, SJC in 18%, TJC in 3% and CRP in 2%.
Conclusions In daily clinical practice Boolean-based criteria was the most stringent among other clinical remission definitions and neverthless was an achievable goal with biologic agents.
Disclosure of Interest None Declared