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Achievement of Remission and Low Disease Activity Definitions in Patients with Rheumatoid Arthritis in Clinical
Till Uhlig1, Elisabeth Lie2, Vibeke Norvang2
1From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Buskerud Central Hospital, Drammen; Department of Rheumatology, St. Olavs Hospital, Trondheim; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.T. Uhlig, MD, Professor, Chief Consultant, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; E. Lie, MD, PhD, Fellow, Department of Rheumatology, Diakonhjemmet Hospital; V. Norvang, MD, Intern, Department of Rheumatology, Diakonhjemmet Hospital; Å.S. Lexberg, MD, Consultant, Department of Rheumatology, Buskerud Central Hospital; E. Rødevand, MD, Head of Department, Department of Rheumatology, St. Olavs Hospital; F. Krøll, MD, Head of Department, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; S. Kalstad, MD, Head of Department, Department of Rheumatology, University Hospital of Northern Norway, University Hospital of Northern Norway; I.C. Olsen, MSc, PhD, Senior Researcher, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, Professor, Head of Department, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo. tillmann.uhlig@medisin.uio.no.
Objective:
To examine the frequency of 6 definitions for remission and 4 definitions for low disease activity (LDA) after starting a disease-modifying antirheumatic drug (DMARD) in patients with rheumatoid arthritis (RA) in clinical practice, and to study whether predictors for achieving remission after 6 months are similar for these definitions.
Methods:
Remission and LDA were calculated according to the 28-joint Disease Activity Score (DAS28), the Clinical Disease Activity Index (CDAI), the Simplified Disease Activity Index (SDAI), the Routine Assessment of Patient Index Data (RAPID3), and both the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission definitions 3 and 6 months after 4992 DMARD prescriptions for patients enrolled in the NOR-DMARD, a 5-center Norwegian register. Prediction of remission after 6 months was also studied.
Results:
After 3 months, remission rates varied between definitions from 8.7% to 22.5% and for LDA from 35.5% to 42.7%, and increased slightly until 6 months of followup. DAS28 and RAPID3 gave the highest and ACR/EULAR, SDAI, and CDAI the lowest proportions for remission. Positive predictors for remission after 6 months were similar across the definitions and included lower age, male sex, short disease duration, high level of education, current nonsmoking, nonerosive disease, treatment with a biological DMARD, being DMARD-naive, good physical function, little fatigue, and LDA.
Conclusion:
In daily clinical practice, the DAS28 and RAPID3 definitions identified remission about twice as often as the ACR/EULAR Boolean, SDAI, and CDAI. Predictors of remission were similar across remission definitions. These findings provide additional evidence to follow treatment recommendations and treat RA early with a DMARD.
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