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J Korean Med Sci. 2016 Dec;31(12):1907-1913. doi: 10.3346/jkms.2016.31.12.1907.

Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis.

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Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Department of Rheumatology, Inje University Ilsan Paik Hospital, Goyang, Korea.
Department of Rheumatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
Department of Rheumatology, Catholic University of Daegu School of Medicine, Daegu, Korea.
Department of Rheumatology, Dong-A University Hospital, Busan, Korea.
Department of Rheumatology, Kyung Hee University Hospital, Seoul, Korea.
Department of Rheumatology, Kyungpook National University Hospital, Daegu, Korea.
Department of Rheumatology, Jeju National University Hospital, Jeju, Korea.
Department of Rheumatology, Chonnam National University Hospital, Gwangju, Korea.
Department of Rheumatology, Yeungnam University Hospital, Daegu, Korea.
Department of Rheumatology, Ewha Womans University Mokdong Hospital, Seoul, Korea.
Department of Rheumatology, Hanyang University Guri Hospital, Guri, Korea.
Department of Rheumatology, Chonbuk National University Hospital, Jeonju, Korea.
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.


Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician's clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.


Arthritis, Rheumatoid; Discordance; Remission

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