Association of 17 Definitions of Remission with Functional Status in a Large Clinical Practice Cohort of Patients with Rheumatoid Arthritis.

Abstract

OBJECTIVE:

To compare the association between different remission criteria and physical function in patients with rheumatoid arthritis followed in clinical practice.

METHODS:

Longitudinal data from the METEOR database were used. Seventeen definitions of remission were tested: American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean-based; Simplified/Clinical Disease Activity Index (SDAI/CDAI); and 14 Disease Activity Score (DAS)-based definitions. Health Assessment Questionnaire (HAQ) ≤ 0.5 was defined as good functional status. Associations were investigated using generalized estimating equations. Potential confounders were tested and sensitivity analyses performed.

RESULTS:

Data from 32,915 patients (157,899 visits) were available. The most stringent definition of remission was the ACR/EULAR Boolean-based definition (1.9%). The proportion of patients with HAQ ≤ 0.5 was higher for the most stringent definitions, although it never reached 100%. However, this also meant that, for the most stringent criteria, many patients in nonremission had HAQ ≤ 0.5. All remission definitions were associated with better function, with the strongest degree of association observed for the SDAI (adjusted OR 3.36, 95% CI 3.01-3.74).

CONCLUSION:

The 17 definitions of remission confirmed their validity against physical function in a large international clinical practice setting. Achievement of remission according to any of the indices may be more important than the use of a specific index. A multidimensional approach, targeted at wider goals than disease control, is necessary to help all patients achieve the best possible functional status.

• Authors: Pedro D Carvalho, Ricardo J O Ferreira, Robert Landewé, David Vega-Morales, Karen Salomon-Escoto, Douglas J Veale, Arvind Chopra, José A P da Silva, Pedro M Machado
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 47 Issue 1 Pg. 20-27 (01 2020) ISSN: 0315-162X [Print] Canada
• PMID: 31043552 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones
• Antirheumatic Agents
• Biological Products

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Aged
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (drug therapy)
• Biological Products (therapeutic use)
• Cohort Studies
• Female
• Functional Status
• Health Surveys
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Remission Induction
• Severity of Illness Index
• Terminology as Topic
• Treatment Outcome