ACR remission criteria and response criteria

Area of Science:

• Rheumatology
• Immunology
• Clinical Medicine

Background:

• The management of rheumatoid arthritis (RA) has significantly advanced with the introduction of numerous disease-modifying antirheumatic drugs (DMARDs) over the past six decades.
• Contemporary research in RA increasingly focuses on the concept of inflammation eradication as a strategy to achieve sustained remission.

Purpose of the Study:

• To review the historical development and current landscape of rheumatoid arthritis remission criteria.
• To analyze the evolution of defining and measuring remission in RA, from early natural history observations to modern composite indices.

Main Methods:

• Historical review of RA remission definitions and criteria.
• Analysis of the American College of Rheumatology (ACR) Remission Criteria and its comparison with various Disease Activity Score (DAS) measures.
• Examination of the applicability of these criteria in routine clinical practice.

Main Results:

• Remission criteria for RA have evolved since 1948, with the 1980 ACR criteria being the most stringent, incorporating clinical signs and erythrocyte sedimentation rate (ESR).
• Comparisons between ACR remission criteria and DAS values have led to the extrapolation of remission targets for modified DAS, SDAI, and CDAI.
• Existing remission criteria were not originally designed for individual patient management targets in clinical practice.

Conclusions:

• While rheumatologists aspire to eradicate inflammation and achieve remission in all RA patients, current criteria have limitations for individual patient goal-setting.
• The pursuit of sustained remission in RA remains a key objective, with ongoing research likely to yield more effective strategies.