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 . 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 .
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.
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
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