Carvalho, PD;
Ferreira, RJO;
Landewé, R;
Vega-Morales, D;
Salomon-Escoto, K;
Veale, DJ;
Chopra, A;
... Machado, PM; + view all
(2019)
Association of seventeen definitions of remission with functional status in a large clinical practice cohort of patients with rheumatoid arthritis.
The Journal of Rheumatology
, 46
(5)
10.3899/jrheum.181286.
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Abstract
OBJECTIVE: To compare the association between different remission criteria and physical function in rheumatoid arthritis patients followed in clinical practice. METHODS: Longitudinal data from the METEOR database were used. Seventeen definitions of remission were tested: ACR/EULAR Boolean-based; Simplified/Clinical Disease Activity Index (SDAI/CDAI); and fourteen Disease Activity Score (DAS)-based definitions. Health Assessment Questionnaire (HAQ)≤0.5 was defined as good functional status. Associations were investigated using generalised estimating equations (GEE). 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 non-remission had HAQ≤0.5. All remission definitions were associated with better function, with the strongest degree of association observed for the SDAI (adjusted OR (95% CI): 3.36 (3.01-3.74)). CONCLUSION: The seventeen 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.
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