Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Performance of the American College of Rheumatology/European League Against Rheumatism (2011) Remission Definition Versus Disease Activity Score, 28-Joint Disease Activity Score and American College of Rheumatology Criteria.

Chiapas-Gasca,  Karla, Amezcua-Guerra,  Luis M., Vargas,  Angélica

Background/Purpose:

Remission has become the treatment goal in rheumatoid arthritis (RA). Current remission criteria have several limitations, the more frequently used are the ACR, DAS and DAS28; so recently, ACR/EULAR proposed a new remission definition. Objective: to compare the performance of the ACR/EULAR remission definition versus DAS, DAS-28 and ACR criteria.

Methods:

Between February 21st and June 10th, 2011, we analyzed the medical records of 198 consecutive outpatients attending our Rheumatology Department. Inclusion criteria were: diagnosis of RA according the ACR 1987 criteria. The database include demographic data, comorbidity, disease duration, extraarticular manifestations, rheumatoid factor (RF), anti-cyclic citrullinated protein antibodies (anti-CCP), erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and drug therapy. Remission was calculated with DAS, DAS28, ACR remission criteria and the ACR/EULAR provisional remission definition. Data are expressed as percentages or mean with standard deviation (SD). Associations were calculated by the unweighted Cohen's kappa (k) index with 95% confidence intervals (95%CI) Differences were estimated by chi-square or unpaired t tests as appropriate.

Results:

47 of the 198 patients fulfilled the ACR/EULAR provisional remission definition; since this is the method we are assessing, in table 1 we report patients characteristics according this evaluation. There was no significant difference according therapy. The distribution of patients in remission and not remission according to each criterion is shown in table 2. The k index between ACR/EULAR vs ACR was 0.61 (0.50–0.72), ACR/EULAR vs DAS was 0.37 (0.27–0.47), ACR/EULAR vs DAS28 was 0.42 (0.32–0.52), ACR vs DAS was 0.57 (0.47–0.68), ACR vs DAS28 0.57 (0.46–0.67), and DAS vs DAS28 0.75 (0.66–0.84). DAS criteria were met by 111 patients, DAS 28 by 103 and ACR by 74. Only 43 of the 198 patients fulfilled remission criteria for all methods.

Table 1. Characteristics of patients according ACR/EULAR results

Remission (n=47)Not remission (n=151)p 
Women (%)41 (87.2)135 (89.4)NS
Age52.7 ± 14.853.5 ± 15NS
Duration of the disease10.8 ± 10.212.7 ± 8.6NS
Extra-articular manifestations (%)10 (21.2)61 (40.3)0.009
Positive RF (%)45 (95.7)143 (94.7)NS
Positive anti-CCP (%)41 (91.1)134 (88.7)NS
ESR in mm/h21.02 ± 9.929.07 ± 11.3<0.0001
CRP in mg/L3.48 ± 1.8512.8 ± 25.70.01
DAS0.93 ± 0.171.8 ± 0.75<0.0001
DAS281.82 ± 0.333.27 ± 1.29<0.0001
Morning stiffness, +1 (2.1)47 (31.1)<0.0001
Fatigue, +0 (0)50 (33.1)<0.0001
Joint tenderness, +5 (10.6)106 (70.1)<0.0001
Tenderness on examination, +3 (6.3)104 (68.8)<0.0001
Joint/tendon sheath swelling, +6 (12.7)126 (83.4)<0.0001
Patients with swollen/tender areas out of DAS280 (0)57 (37.7)<0.001
Data are expressed in mean ± SD unless otherwise specified. NS, no significance; +, positive

Table 2. Patients on remission according the different criteria

CriteriaRemissionNot remission
ACR74124
DAS11187
DAS2810395
ACR/EULAR47151

Conclusion:

The recently proposed ACR/EULAR remission definition seems to be more stringent to discriminate patients on remission, whereas remission is easier to achieve with DAS and DAS-28.

To cite this abstract, please use the following information:
Chiapas-Gasca, Karla, Amezcua-Guerra, Luis M., Vargas, Angélica; Performance of the American College of Rheumatology/European League Against Rheumatism (2011) Remission Definition Versus Disease Activity Score, 28-Joint Disease Activity Score and American College of Rheumatology Criteria. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :340
DOI:

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