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 New ACR/EULAR Remission Criteria Compared to DAS28 Remission in Unselected Real-Life Patients with Rheumatoid Arthritis.
Huscher1, Dörte, Thiele2, Katja, Bischoff2, Sascha, Backhaus3, Marina, Aringer4, Martin, Kotter5, Ina, Zink1, Angela
German Rheumatism Research Centre and Charité University Medicine, Berlin, Germany
German Rheumatism Research Centre, Berlin, Germany
Charité University Medicine, Berlin, Germany
Uniklinikum TU Dresden, Dresden, Germany
Department of Internal Medicine II, Rheumatology Division, Tübingen, Germany
The new ACR/EULAR remission criteria comprise two equally applicable definitions: either a boolean definition (number of swollen and tender joints each <=1, CRP<=1 mg/dl, and patient global assessment <=1 [NRS 010]), or a simplified disease activity index (SDAI) score of <= 3.3. Both definitions are more stringent than the established EULAR criterion based on a DAS28<2.6. Even though the criteria have been developed data-driven, it has to be further evaluated how these criteria perform in different cohorts of real-life patients.
We used cross-sectional data of 6,864 RA patients, enrolled in the National Database of the German Collaborative Arthritis Centres between 2007 and 2009, for whom all 3 remission criteria could be calculated. Patients seen in more than one year were included only once. The functional status was measured by the Hannover Functional Status Questionnaire (FFbH) in percent of full function (0100%). For patients in remission according to one ouf of the three criteria the functional status was compared to data from the age and sex matched general population.
75% of the patients were female, their mean age was 61.5 years, the median disease duration 9.1 years, and the mean DAS28 3.4. 1,931 patients (28%) were in DAS28 remission, 476 (7%) in boolean and 740 (11%) in SDAI remission.
If patients fulfilled the new, but not the DAS28 criterion, this was mainly due to high ESR (mean ESR 39.0 for patients in boolean but not DAS28 remission, and 39.1 for those in SDAI but not DAS28 remission). If patients fulfilled the DAS28 but not the new criteria, this was due to patient global assessments exceeding 1 (mean patient global for DAS28 remission but not boolean: 3.4, DAS28 remission but not SDAI: 3.6).
Compared to the DAS28 criterion, the new criteria select more stringently patients with low pain (mean 1.0 for boolean and 1.3 for SDAI compared to 2.8 for DAS28 remission), low fatigue (1.1, 1.3 and 2.6, respectively) and good function (92.4%, 91.8% and 84.3% of full function, respectively).
Compared to a population cohort (Fig.1), patients in remission according to the new criteria have a functional status that is even superior to their age and sex matched population counterparts.
The RA new remission criteria stringently select patients who have nearly no functional limitation, pain or fatigue. Since the functional status of these patients is better than expected from the age and sex matched population, a weakness of the new criteria could be that patients with disabling co-morbid conditions cannot reach remission even if their RA is entirely inactive. Other disabling conditions might influence the self-rating, even if patients are asked explicitely to refer to the RA only. More research is needed to better understand the influence of co-morbidity on patients' self assessments and the consequences for the definition of remission.
To cite this abstract, please use the following information:
Huscher, Dörte, Thiele, Katja, Bischoff, Sascha, Backhaus, Marina, Aringer, Martin, Kotter, Ina, et al; Performance of the New ACR/EULAR Remission Criteria Compared to DAS28 Remission in Unselected Real-Life Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2460