1229 - Different Remission Definitions Capture Different Proportions of patients with Rheumatoid Arthritis Treated in Clinical Practice

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Till Uhlig1, Elisabeth Lie1, Cecillie Kaufmann2, Erik Rodevand3, Knut Mikkelsen4, Synnøve Kalstad5 and Tore K. Kvien1, 1Diakonhjemmet Hospital, Oslo, Norway, 2Buskerud Central Hospital, Drammen, Norway, 3St. Olav Hospital, Trondheim, Norway, 4Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway, 5University Hospital in Northern Norway, Tromsø, Norway
Presentation Number: 1229

Background/Purpose:

Clinical remission is the treatment target in rheumatoid arthritis (RA) and several composite indices are available for evaluation of remission states, including the newly formulated ACR/EULAR definition. These definitions have not been applied in real life daily clinical practice.

The purpose of this study was to examine how often clinical remission is achieved in clinical practice using existing definitions, and to test how well patients in remission preserve physical function.

Method:  

Data for this study were provided by the NOR-DMARD register in all 5788 patients with RA started with a synthetic (n=3875) or biological DMARD (n=1913). Age was mean (SD) 55.3 (29.9) yrs, disease duration was 8.2 (9.6) yrs, 73.3% of patients were females.

Applied definitions for clinical remission included the Disease Activity Score based on 28 joint counts (DAS28) <2.6, the Simplified Disease Activity Index (SDAI) ≤3.3, the Clinical Disease Activity Index (CDAI) ≤2.8, Routine Assessment of Patient Index Data (RAPID3, range 0-10) ≤1, and the preliminary ACR/EULAR remission definition where in the Boolean (BOOL) application tender joint count, swollen joint count, patient global assessment (scale 0-10), and CRP (mg/dL) all must be ≤1. ACR/EULAR remission is warranted if either ACR/EULAR BOOL is satisfied or SDAI ≤3.3. We also explored a practical definition of ACR/EULAR BOOL without CRP (ACR/EULAR PRAC). Data after 3 and 6 months of treatment were used for assessment of remission. Then patients with remission at 3 months were examined for deterioration of physical function (measured by the modified Health Assessment Questionnaire [MHAQ]) between months 3 and 12, likewise remission at month 6 for deterioration between months 6 and 12.
Result:

The table shows percentages of patients in remission after 3 months and 6 months, and further among these patients with remission at 3 and 6 months percentages of patients with no deterioration in MHAQ until 12 months. SDAI, CDAI and the new ACR/EULAR definition for remission are most stringent and classify 7-8% as in remission after 3 months of DMARD treatment, and 9-11% after 6 months. DAS28 and RAPID3 classify most patients as in remission. All remission definitions performed similar in identifying patients with preserved physical function.

 

DAS28

SDAI

CDAI

RAPID3

ACR/EULAR

BOOL

ACR/EULAR

 

ACR/EULAR

PRAC

3 mts

19.1

7.6

8.1

17.0

6.9

9.3

8.1

MHAQ non progr. 3-12 mts

65.7

63.9

64.9

65.2

64.2

63.6

65.6

6 mts

24.7

10.5

11.3

19.8

9.0

12.3

11.0

MHAQ non-progr. 6-12 mts

69.6

73.5

73.6

69.8

74.9

72.6

73.7

 

Conclusion:

Definitions of remission differ regarding the proportion of patients classified as in remission after 3 and 6 months of DMARD treatment in clinical practice. However, no individual definition seems superior in identifying patients who preserve physical function until 12 months.


Keywords: DMARDs, Health Assessment Questionnaire, remission and rheumatoid arthritis (RA)

Disclosure: T. Uhlig, None; E. Lie, None; C. Kaufmann, None; E. Rodevand, None; K. Mikkelsen, None; S. Kalstad, None; T. K. Kvien, None.