In recent years it has been shown that remission may be a realistic goal to aim for when treating rheumatoid arthritis. How to define remission has been a matter of debate, often initiated by the observation that a certain definition allows for the presence of some symptoms or signs that would indicate residual disease activity, or by the expectation that with time, residual disease activity would become apparent. More stringent definitions, with longer follow up requirements, are then proposed. When aiming to be a gold standard of absent disease, to test new methods of measuring disease activity, remission definitions would be have to be so stringent as to denote ‘cure’, if this exists in RA.
In daily practice and in most dictionaries remission, coming from Latin remittere, to send back, is called a situation where in a chronic disease (remission does not mean cured), by active intervention (there is no ‘spontaneous remission’, only regression or resolution) there are no longer symptoms. This means that patient and physician need only to agree that the patient is free of clinical manifestations of the disease, and that laboratory signs, lingering evidence of chronicity, persistence of risk factors or abnormal cells or cell activities, need not be absent. Used in daily practice, time efficient methods are needed, that provide sufficient security to allow treatment decisions based on the result.
In RA, where previous disease activity may have caused damage, this may result in symptoms which are not clinical manifestations of disease activity. Such symptoms do not preclude that remission may be achieved. Composite scores which include signs of inflammation may help to assess if there is ‘remission with symptoms’. Various composite scores come with their own definition of remission, and these may not all identify the same patients.
In research papers on cohorts and observational studies, it is sufficient to use clinical remission criteria. In order to be able to compare outcomes between studies, it would be helpful to report data using the same remission definition in each study. Whether one definition is better than the others and if so, why, will be discussed.
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