Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Rate of Remission in Clinical RA Patients by ACR/EULAR Criteria.
Shahouri3, Shadi H., Anderson5, James D., Busch2, Ruth E., Shaver4, Timothy S., Wang3, Shirley Y., Weidensaul1, David N., Bergman6, Martin J.
ARCKArthritis & Rheum Clinics KS, Wichita, KS
Arthritis & Rheum Clinic, Wichita, KS
Arthritis & Rheum Clinic of KS, Wichita, KS
Arthritis & Rheum Clinics KS, Wichita, KS
Arthritis & Rheum Clinics KS, Leawood, KS
Arthritis and Rheumatology, Ridley Park, PA
Natil Data Bank for Rheumatic, Wichita, KS
Univ of Nebraska Med Ctr, Omaha, NE
Remission is the most desirable outcome of RA treatment, but a multiplicity of definitions has hampered the measured of remission in the community. The ACR/EULAR remission committee has recently made recommendations for RA clinical trials, and also provided possible alternatives for clinical practice. We explored the clinic practice suggestions and determined the rate of remission in a large multicenter RA clinical practice.
From 1,350 consecutive RA patients seen in clinical practice between January 2007 and March 2010 during 12,801 visits, we studied 1,079 patients with ESR data during 5,289 clinical visits. ESR missing data was primarily a function of patient medical insurance. We calculated a series of remission measures according to the ACR/EULAR recommendations.
Each patient contributed an average of 4.9 observations (range 124). We determined the rate of remission by modeling all observation using general estimating equations. We also included ACR/EULAR-3 to define the limit of remission without ESR and we used ACR/EULAR-3 + Low ESR to explore a more restrictive ESR limit based on the distribution of ESR in the community.
Patients' age and RA duration were 58.8 (SD 13.9) years and 10.0 (10.1) years, and 75% of patients were women.
The rate of remission ranged from 5.1% to 7.5% according to the ACR/EULAR recommendation. The rate rose to 8.4% from 6.0% when ESR was eliminated and fell to 4.0% when ESR limits were tightened. In the ACR/EULAR-3 and the ESR criteria, the rate of remission was not higher in biologic treated patients, but was higher in all criteria that included MD global (ACR/EULAR-4 and ACR/EULAR CDAI).
Overall, the rate of remission using contemporary RA treatment in the community is between 5.1% to 7.5%. These rates are substantially lower than reported in clinical trials using DAS-28 criteria. Criteria that include physician global tend to find more benefit with biologic therapy than criteria that do not include physician measures.
|ACR/EULAR-3||SJ28 <=1 & TJ28 <=1 & Pt global <=1|
|ACR/EULAR-4||SJ28 <=1 & TJ28 <=1 & Pt global <=1 & MD global <=1|
|ACR/EULAR CDAI||(SJ28 + TJ28 + Pt global + MD global) <= 2.8|
|ACR/EULAR-3 + ESR||SJ28 <=1 & TJ28 <=1 & Pt global <=1 & (ESR <30 mm [women] or < 10 mm [men])|
|ACR/EULAR-3 + Low ESR||SJ28 <=1 & TJ28 <=1 & Pt global <=1 & (ESR <22 mm [women] or <11 mm [men])|
|Name||Rate (95% CI)||Biologic effect (On vs. not on)|
|ACR/EULAR-3||8.4% (7.2, 9.6)||9.3% vs. 7.7%, p = 0.068|
|ACR/EULAR-4||5.1% (4.2, 6.1)||6.7% vs. 4.0%, p <0.001|
|ACR/EULAR CDAI||7.5% (6.4, 8.7)||10.3% vs. 5.6%, p <0.001|
|ACR/EULAR-3 + ESR||6.0% (4.9, 7.0)||6.4% vs. 5.5%, p = 0.229|
|ACR/EULAR-3 + Low ESR||4.0% (3.2, 4.9)||4.3% vs. 3.8%, p = 0.408|
To cite this abstract, please use the following information:
Shahouri, Shadi H., Anderson, James D., Busch, Ruth E., Shaver, Timothy S., Wang, Shirley Y., Weidensaul, David N., et al; Rate of Remission in Clinical RA Patients by ACR/EULAR Criteria. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :331