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Association of seventeen definitions of remission with functional status in a large clinical practice cohort of patients with rheumatoid arthritis

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.

Type: Article
Title: Association of seventeen definitions of remission with functional status in a large clinical practice cohort of patients with rheumatoid arthritis
Location: Canada
DOI: 10.3899/jrheum.181286
Publisher version: https://doi.org/10.3899/jrheum.181286
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Department of Neuromuscular Diseases
URI: https://discovery.ucl.ac.uk/id/eprint/10073287
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