Background Patients reaching remission for joint counts and CRP according to the ACR/EULAR Boolean definition fo remission (value<=1/10), but not remission for patient global assessment (PGA), are termed in ‘near-remission’(1). PGA may represent the wider impact of rheumatoid arthritis (RA) including psychological well-being and coping skills, rather than just the pathophysiological severity of the disease (2) and may include several concepts measured by the EULAR patient-derived RA Impact of Disease (RAID) score (3).
Objectives To assess whether psychological components of the RAID score explain the elevated PGA for patients in near-remission.
Methods The RAID database, based on an international multicenter cross-sectional study of consecutive RA patients from 12 European countries, was used (3). Each component of the RAID score ranges from 0 (no impact) to 10 (high impact). Patients in near-remission were compared to those in remission and not in remission for the proportion of patients with a score <=1/10, in each of the RAID components. Non-parametric comparisons were performed.
Results In total, 359 patients had complete data for this analysis: mean (±standard deviation) age 55.8±13.0 yrs, disease duration 12.6±10.5 yrs, 76.4% women. Mean RAID score was 4.3±2.2. With the ACR/EULAR Boolean definition, only 22 (6.1%) were in remission and 53 (14.8%) were in near-remission. In near-remission patients, the mean PGA was 3.3±1.5, and the mean RAID score was 3.6±1.8. The components of the RAID were mostly all >1/10 but specifically, physical well-being, fatigue, pain and functional assessment were more frequently >1/10 (94%, 89%, 87%, 83%) than sleep, coping or emotional well-being in these patients (79%, 79%, 74%, all p<0.05).
Conclusions The new definition of remission is extremely stringent and rarely attained for patients with long-standing RA. Near-remission is a more frequently achieved status. In this sample, psychological distress and lack of coping did not explain the raised PGA of near-remission, which was better explained by higher physical components of the RAID score. More work is needed to understand the patient perspective regarding remission.
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Disclosure of Interest None Declared
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