Defining remission in rheumatoid arthritis: Results of an initial american college of rheumatology/european league against rheumatism consensus conference

Abstract

Objective. Due to advances in rheumatoid arthritis (RA) therapies over the last few years, an increasing proportion of patients are able to achieve a state of remission. However, the definition of remission is unclear. Currently, randomized controlled trials around the world use different remission definitions and consequently measure different aspects of a patient's disease state. The need for a uniform definition of remission is vital for research findings to be correctly interpreted. Methods. The American College of Rheumatology (ACR) constituted a committee that included international clinical researchers, trialists, and clinical epidemiologists in order to redefine remission in RA. This group was asked to study current definitions of remission, explore the theoretical underpinning of the concept of remission, and develop a research agenda that would inform future work in the development of an ACR definition of remission. Results. In its first meeting, the committee preferred to develop a strict definition, implying no or very low disease activity. Such a definition would need to be validated against long-term outcome, e.g., physical function and damage. Conclusion. The committee decided to consider both a definition for trials and a modified version for clinical practice. Since the first meeting, the ACR and the European League Against Rheumatism (EULAR) have decided to sponsor this initiative as an official ACR/EULAR collaboration.

IL-37 Alleviates Rheumatoid Arthritis by Suppressing IL-17 and IL-17–Triggering Cytokine Production and Limiting Th17 Cell Proliferation

“…The classification of RA fulfilled the 1987 and 2010 American College of Rheumatology criteria (13,14). RA patients were divided into active (n = 26) and inactive (n = 23) groups, according to their 28-joint disease activity score (DAS28); active disease is defined as DAS28 $ 3.2, based on the European League Against Rheumatism diagnostic criteria (15). At the time of sample acquisition, 38 patients were being treated with prednisone, and 11 patients were not.…”

Improving the Routine Management of Rheumatoid Arthritis: The Value of Tight Control

“…Although recent advances in treatment have led to an increase in the proportion of patients reaching a state of remission 22 there is no "gold standard" measurement of disease activity and remission in RA 4 . Numerous pooled indices have been developed to measure disease activity, each of which incorporates 3-10 different assessments 23,24,25,26,27,28,29,30,31 .…”

“…Indeed, a recent study in which patients' disease activity was assessed by different indices (including DAS28, SDAI, and CDAI) demonstrated that different proportions of patients were found to be in remission depending on the definition used 42 ; further comparisons of disease activity indices are therefore required. A collaborative committee between ACR and EULAR has been convened to develop a strict definition of remission that correlates with very low or no disease activity 22 .…”

Acute Phase Proteins in Prototype Rheumatic Inflammatory Diseases

“…Acute phase reactants were included as one of the 3 most important variables, beside tender and swollen joint counts, in defining remission of RA at initial ACR/EULAR Consensus Conference (van Tuyl, Vlad et al 2009) and normal CRP and ESR levels are one of the three criteria defining disease inactivity in juvenile RA. Patients with 25 very active RA had significantly higher SAA levels in the serum than 23 patients with moderately/mildly active or inactive disease (Maury, Teppo et al 1982).…”