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Discordance between tender and swollen joint count as well as patient's and evaluator's global assessment may reduce likelihood of remission in patients with rheumatoid arthritis and psoriatic arthritis: data from the prospective multicentre NOR-DMARD study
  1. Brigitte Michelsen1,2,
  2. Eirik Klami Kristianslund1,
  3. Hilde Berner Hammer1,
  4. Karen Minde Fagerli1,
  5. Elisabeth Lie1,
  6. Ada Wierød3,
  7. Synøve Kalstad4,
  8. Erik Rødevand5,
  9. Frode Krøll6,
  10. Glenn Haugeberg7,8,
  11. Tore K Kvien1
  1. 1Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
  3. 3Department of Rheumatology, Vestre Viken/Drammen Hospital, Drammen, Norway
  4. 4Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
  5. 5Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway
  6. 6Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
  7. 7Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
  8. 8Norwegian University of Science and Technology, Trondheim, Norway
  1. Correspondence to Dr Brigitte Michelsen, Department of Rheumatology, Diakonhjemmet Hospital, P. O. Box 23, Vinderen, Oslo N0319, Norway; brigitte_michelsen{at}


Objective To investigate the predictive value of discordance between (1) tender and swollen joint count and (2) patient's and evaluator's global assessment on remission in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Methods From the prospective, multicentre Norwegian-Disease-Modifying Antirheumatic Drug study, we included patients with RA and PsA starting first-time tumour necrosis factor inhibitors and DMARD-naïve patients starting methotrexate between 2000 and 2012. The predictive value of ΔTSJ (tender minus swollen joint counts) and ΔPEG (patient's minus evaluator's global assessment) on remission was explored in prespecified logistic regression models adjusted for age, sex, disease duration and smoking.

Results A total of 2735 patients with RA and 1236 patients with PsA were included (mean (SD) age 55.0 (13.5)/48.3 (12.4) years, median(range) disease duration 0.7 (0.0–58.0)/1.3 (0.0–48.3) years, 69.7/48.4% females). Baseline ΔTSJ/ΔPEG reduced the likelihood of achieving DAS28<2.6, SDAI≤3.3, CDAI≤2.8, ACR/EULAR Boolean and DAPSA<4 remission after 3 and 6 months in RA (OR 0.95–0.97, p<0.001/OR 0.96–0.99, p≤0.01) and PsA (OR 0.91–0.94, p≤0.004/OR 0.89–0.99, p≤0.002), except for ΔPEG and 6-month DAS28 remission in PsA.

Conclusions Discordance between patient's and physician's evaluation of disease activity reflected through ΔTSJ and partly ΔPEG may reduce likelihood of remission in RA and PsA. The findings are relevant for use of the treat-to-target strategy in individual patients.

  • Rheumatoid Arthritis
  • Psoriatic Arthritis
  • Disease Activity
  • Treatment

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  • Handling editor Hans WJ Bijlsma

  • Contributors BM, EKK, HBH, KMF, EL, GH and TKK were responsible for study design. AW, SK, ER, FK and TKK were responsible for data acquisition. BM analysed the data and wrote the manuscript. All authors critically revised the manuscript and approved the final version.

  • Funding The study was funded through a clinical research fellowship from Diakonhjemmet Hospital, originating from a network grant from South-Eastern Health Authority. Data collection in NOR-DMARD was partly funded through unrestricted grants from AbbVie, BMS, MSD, Pfizer (Wyeth), Roche and UCB.

  • Competing interests HBH has received fees for speaking and/or consulting from AbbVie, BMS, Pfizer, UCB, Roche, MSD and Novartis. GH has received fees for speaking and/or consulting from AbbVie, BMS, AMGEN, GSK, Mundifarma, Takeda, Eli Lilly, Pfizer, MSD, Novartis, Roche and UCB and received research funding to Martina Hansens Hospital and The Hospital of Southern Norway Trust from Pfizer. TKK has received fees for speaking and/or consulting from AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Epirus, Hospira-Pfizer, Merck-Serono, MSD, Novartis, Orion Pharma, Pfizer, Roche, Sandoz and UCB and received research funding to Diakonhjemmet Hospital from AbbVie, BMS, MSD, Pfizer, Roche and UCB.

  • Ethics approval Regional Committee for Medical and Health Research Ethics in Eastern Norway.

  • Provenance and peer review Not commissioned; externally peer reviewed.