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J Rheumatol. 2020 Jan;47(1):20-27. doi: 10.3899/jrheum.181286. Epub 2019 May 1.

Association of 17 Definitions of Remission with Functional Status in a Large Clinical Practice Cohort of Patients with Rheumatoid Arthritis.

Author information

1
From the Rheumatology Department, Centro Hospitalar Universitário do Algarve, Faro; Lisbon Academic Medical Center, Lisbon; Algarve Biomedical Center, Faro; Health Sciences Research Unit: Nursing (UICiSA:E), Escola Superior de Enfermagem de Coimbra, Coimbra; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra; Rheumatology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Amsterdam Rheumatology Center, Amsterdam University Medical Center (UMC); Zuyderland Medical Center, Heerlen, the Netherlands; Hospital Universitario "Dr. José Eleuterio González"/Universidad Autónoma de Nuevo León, Monterrey, Mexico; University of Massachusetts Medical School, Rheumatology Center, Worcester, Massachusetts, USA; Dublin Academic Medical Centre, Dublin, Ireland; Centre for Rheumatic Diseases, Pune, India; Centre for Rheumatology Research, and Medical Research Council (MRC) Centre for Neuromuscular Diseases, University College London, London; Rheumatology Department, Northwick Park Hospital, London North West University Healthcare National Health Service (NHS) Trust, London, UK. pedrodcsc@gmail.com.
2
P.D. Carvalho, MD, Rheumatology Department, Centro Hospitalar Universitário do Algarve, and Lisbon Academic Medical Center, and Algarve Biomedical Center; R.J. Ferreira, Rheumatology Department, Centro Hospitalar Universitário de Coimbra, and UICiSA:E, Escola Superior de Enfermagem de Coimbra; R. Landewé, MD, PhD, Amsterdam Rheumatology Center, and Zuyderland Medical Center; D. Vega-Morales, MD, PhD, Hospital Universitario "Dr. José Eleuterio González"/ Universidad Autónoma de Nuevo León; K. Salomon-Escoto, MD, PhD, University of Massachusetts Medical School, Rheumatology Center; D.J. Veale, MD, PhD, Dublin Academic Medical Centre; A. Chopra, MD, PhD, Centre for Rheumatic Diseases; J.A. da Silva, MD, PhD, Rheumatology Department, Centro Hospitalar Universitário de Coimbra, and iCBR, Faculty of Medicine, University of Coimbra; P.M. Machado, MD, PhD, Centre for Rheumatology Research, and MRC Centre for Neuromuscular Diseases, University College London, and Rheumatology Department, Northwick Park Hospital, London North West University Healthcare NHS Trust. pedrodcsc@gmail.com.
3
From the Rheumatology Department, Centro Hospitalar Universitário do Algarve, Faro; Lisbon Academic Medical Center, Lisbon; Algarve Biomedical Center, Faro; Health Sciences Research Unit: Nursing (UICiSA:E), Escola Superior de Enfermagem de Coimbra, Coimbra; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra; Rheumatology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Amsterdam Rheumatology Center, Amsterdam University Medical Center (UMC); Zuyderland Medical Center, Heerlen, the Netherlands; Hospital Universitario "Dr. José Eleuterio González"/Universidad Autónoma de Nuevo León, Monterrey, Mexico; University of Massachusetts Medical School, Rheumatology Center, Worcester, Massachusetts, USA; Dublin Academic Medical Centre, Dublin, Ireland; Centre for Rheumatic Diseases, Pune, India; Centre for Rheumatology Research, and Medical Research Council (MRC) Centre for Neuromuscular Diseases, University College London, London; Rheumatology Department, Northwick Park Hospital, London North West University Healthcare National Health Service (NHS) Trust, London, UK.
4
P.D. Carvalho, MD, Rheumatology Department, Centro Hospitalar Universitário do Algarve, and Lisbon Academic Medical Center, and Algarve Biomedical Center; R.J. Ferreira, Rheumatology Department, Centro Hospitalar Universitário de Coimbra, and UICiSA:E, Escola Superior de Enfermagem de Coimbra; R. Landewé, MD, PhD, Amsterdam Rheumatology Center, and Zuyderland Medical Center; D. Vega-Morales, MD, PhD, Hospital Universitario "Dr. José Eleuterio González"/ Universidad Autónoma de Nuevo León; K. Salomon-Escoto, MD, PhD, University of Massachusetts Medical School, Rheumatology Center; D.J. Veale, MD, PhD, Dublin Academic Medical Centre; A. Chopra, MD, PhD, Centre for Rheumatic Diseases; J.A. da Silva, MD, PhD, Rheumatology Department, Centro Hospitalar Universitário de Coimbra, and iCBR, Faculty of Medicine, University of Coimbra; P.M. Machado, MD, PhD, Centre for Rheumatology Research, and MRC Centre for Neuromuscular Diseases, University College London, and Rheumatology Department, Northwick Park Hospital, London North West University Healthcare NHS Trust.

Abstract

OBJECTIVE:

To compare the association between different remission criteria and physical function in patients with rheumatoid arthritis followed in clinical practice.

METHODS:

Longitudinal data from the METEOR database were used. Seventeen definitions of remission were tested: American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean-based; Simplified/Clinical Disease Activity Index (SDAI/CDAI); and 14 Disease Activity Score (DAS)-based definitions. Health Assessment Questionnaire (HAQ) ≤ 0.5 was defined as good functional status. Associations were investigated using generalized estimating equations. 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 nonremission had HAQ ≤ 0.5. All remission definitions were associated with better function, with the strongest degree of association observed for the SDAI (adjusted OR 3.36, 95% CI 3.01-3.74).

CONCLUSION:

The 17 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.

KEYWORDS:

DISEASE ACTIVITY; DISEASE ACTIVITY SCORE; REMISSION; RHEUMATOID ARTHRITIS

PMID:
31043552
DOI:
10.3899/jrheum.181286

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