Table 6

American College of Rheumatology/European League Against Rheumatism definitions of remission in rheumatoid arthritis clinical trials*

Boolean-based definition
At any time point, patient must satisfy all of the following:
  • Tender joint count ≤1

  • Swollen joint count ≤1

  • C reactive protein ≤1 mg/dl

  • Patient global assessment ≤1 (on a 0–10 scale)

Index-based definition
At any time point, patient must have a Simplified Disease Activity Index score of ≤3.3§
  • * See text and tables 2 and 3 for recommendations regarding assessment of remission in clinical practice settings.

  • For tender and swollen joint counts, use of a 28-joint count may miss actively involved joints, especially in the feet and ankles, and it is preferable to include feet and ankles also when evaluating remission.

  • For the assessment of remission we suggest the following format and wording for the global assessment questions. Format: a horizontal 10-cm visual analog or Likert scale with the best anchor and lowest score on the left side and the worst anchor and highest score on the right side. Wording of question and anchors: For patient global assessment, ‘Considering all of the ways your arthritis has affected you, how do you feel your arthritis is today?’ (anchors: very well-very poor). For physician/assessor global assessment, ‘What is your assess- ment of the patient's current disease activity?’ (anchors: none- extremely active).

  • § Defined as the simple sum of the tender joint count (using 28 joints), swollen joint count (using 28 joints), patient global assessment (0–10 scale), physician global assessment (0–10 scale), and C reactive protein level (mg/dl).