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Assessment of control of rheumatoid arthritis disease activity
Karen I Salomon-Escoto1, Ellen M Gravallese, Jonathan Kay
1University of Massachusetts Medical School, Rheumatology Center, UMass Memorial Medical Center, Worcester, USA. karen.salomon-escoto@umassmemorial.org
Abstract:
As very effective targeted biological therapies have become available to treat rheumatoid arthritis (RA), remission is now the goal of treatment. Since 1981, efforts have been undertaken to develop criteria for clinical remission in RA. Although several different measures of disease activity have been proposed, many issues remain unresolved. Active joint inflammation, even if involving only a few joints, negatively impacts a patient's quality of life and may ultimately result in structural damage. Thus, a low disease activity state (LDAS), which has been adopted as the target in clinical trials of 'treat to target', may not be the optimal treatment target in clinical practice. Similarly, the definitions of remission used in clinical trials may not be appropriate for use in daily clinical practice because some allow for the presence of several tender and swollen joints. Measures of disease activity do not necessarily correlate with structural remission, which implies halting progression of radiographic evidence of damage over time. Because no single measure of RA disease activity fully quantifies the global burden of disease, rheumatologists must follow multiple parameters to assess disease activity thoroughly and to adjust treatment optimally.
Insights
Achieving remission is the goal for rheumatoid arthritis (RA) treatment. Current remission criteria may not fully capture disease burden or prevent joint damage, necessitating comprehensive assessment.
Area of Science:
- Rheumatology
- Clinical Immunology
- Pharmacology
Background:
- Effective targeted biologic therapies have shifted rheumatoid arthritis (RA) treatment goals towards remission.
- Developing robust criteria for clinical remission in RA has been ongoing since 1981.
- Existing measures of RA disease activity and remission definitions face challenges in clinical practice.
Purpose of the Study:
- To evaluate the adequacy of current rheumatoid arthritis remission criteria.
- To determine if low disease activity state (LDAS) is an optimal treatment target in clinical practice.
- To highlight the need for comprehensive assessment beyond single disease activity measures.
Main Methods:
- Review of existing literature on rheumatoid arthritis (RA) remission criteria.
- Analysis of proposed measures for RA disease activity.
- Comparison of clinical trial definitions versus clinical practice requirements for remission.
Main Results:
- Current remission criteria may not align with optimal clinical practice or prevent long-term structural damage.
- Low disease activity state (LDAS) may be insufficient as a treatment target in routine care.
- Disease activity measures do not always correlate with structural remission (halting radiographic progression).
Conclusions:
- No single measure adequately quantifies the full burden of rheumatoid arthritis (RA).
- Rheumatologists must utilize multiple parameters for thorough RA assessment.
- Optimal RA treatment adjustment requires monitoring various disease activity indicators.
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