Article Text
PDF
Abstract
Background Different criteria for remission in rheumatoid arthritis (RA) have been developed from a core data set of 7 measures for the DAS28, CDAI and RAPID3. A committee of the American College of Rheumatology and the European League Against Rheumatism (ACR/EULAR) proposed two criteria: “Boolean” criteria with 4 measures – TJC28, SJC28, CRP, PATGL – all ≤1; and SDAI ≤3.3 [1]. A recent study indicated that remission criteria based on RAPID3 ≤3 with ≤1 swollen joint (RAPID3RJ1) gave similar results to the Boolean and SDAI criteria, but would be considerably more feasible for usual care [2].
Objectives To analyze the capacity of 6 remission criteria, based on a health assessment questionnaire (HAQ) in the ESPOIR routine care cohort of early arthritis patients, to predict a good outcome for physical function 12 months later.
Methods The ESPOIR cohort includes patients with early RA who had baseline DAS28 ≥5.1 and received routine care chosen by their doctor. A good outcome for physical function on the HAQ was defined as no change and absolute score of ≤0.5 at both the 12 and 24 month time points. Remission was defined at 12 months according to 6 criteria: ACR/EULAR Boolean (TJC28, SJC28, CRP, PATGL all ≤1), SDAI (≤3.3), CDAI (≤2.8), DAS28 (≤2.6), RAPID3 (≤3) and RAPID3RJ1 (RAPID3 ≤3 and ≤1 swollen joint). Analyses were conducted to determine whether patients who met different criteria for remission at 12 months were more likely to have a good functional outcome 12 months later (at 24 months), by comparing patients who were classified as in remission or not in remission using a chi square test, and likelihood ratios for each of the 6 remission criteria.
Results 656 patients had available data to evaluate remission; 76% were women and mean age was 48 years. The median duration of disease at baseline was 5 months; 40% of patients were ACPA-positive and 44% rheumatoid factor-positive. Patients who were in remission according to each of 6 criteria were significantly more likely to have a good functional status outcome 12 months later (Table); nonetheless, 45-50% of patients not in remission also had a good functional outcome 12 months later. Positive likelihood ratios for having a good functional outcome were 3.8 and 4.0 for Boolean and RAPID3RJ1; 2.8-3.1 for RAPID3, CDAI and SDAI; and 1.8 for DAS28 criteria.
Conclusions Remission according to the 6 criteria predicts a good functional outcome 12 months later. The highest positive likelihood ratios are seen for the Boolean and RAPID3RJ1 criteria.
References
Felson DT, Smolen JS, Wells G, et al. Arthritis Rheum 2011;63:573-586.
Castrejón I, Dougados M, Combe B, et al. J Rheumatol 2013; in press
Disclosure of Interest None Declared