RA remission redefined

Two new provisional definitions of rheumatoid arthritis (RA) remission have been released by the American College of Rheumatology (ACR). To be considered in remission, according to researchers, a person with RA who is enrolled in a clinical trial would need to meet 1 of the following:

•Tender joint count, swollen joint count (on 28-joint counts), C-reactive protein level (in mg/dL), and patient global assessment scores (on a scale of 0 to 10) all less than or equal to 1.

•Simplified Disease Activity Index score (scores from the 4 outcome measures and a physician global assessment score added to create one number between 0 and about 100) less than or equal to 3.3.

The ACR and the European League Against Rheumatism, together with the Outcome Measures in Rheumatology initiative, convened a committee to create a definition of RA remission that could be used by rheumatologists involved in clinical trials. A review of several RA disease activity measures helped the investigators arrive at the provisional definitions, which are in line with the treatment goal of reversing disease activity to prevent future damage.

The investigators identified situations that might indicate a person with RA is in remission and examined how useful each candidate definition of remission would have been if used in existing RA trials. They wanted to know whether a candidate definition of remission would have added value to, and successfully predicted a good outcome in, RA clinical trials. For a good outcome, they focused on whether a candidate definition of remission would offer clinical proof that joint damage had been halted and on functional outcomes of remission-whether a patient could accomplish daily activities optimally.

After reviewing how each candidate definition would work in existing RA trials and determining how a patient’s assessment of overall health and pain levels would play a role in remission definitions, the investigators determined that a patient with RA must satisfy 1 of the 2 preliminary definitions to be considered in remission. Next, they will evaluate how useful and accurate these definitions are when incorporated into clinical practice.

The study was to be published in the March issue of Arthritis & Rheumatism. For more information, visit the ACR Web site at http://www.rheumatology.org. Or, contact the organization at ACR, 2200 Lake Boulevard NE, Atlanta, GA 30319-5312; telephone: (404) 633-3777; fax: (404) 633-1870.