Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Does Defining Remission in RA Matter to Patients?

Multi-dimensional remission (MDR) occurs in about one-third of DAS-28-remission patients and was associated with better patient-reported outcome measures in rheumatoid arthritis (RA), a new study found. The cross-sectional study included 605 patients who were selected from an inflammatory arthritis register using DAS28(CRP)<2.6. Demographic, clinical, and patients’ reported outcomes (PRO) data were collected. Ultrasound power Doppler synovitis (n=364) and T-cell subsets (n=297) were also measured. Researchers found:

  • Overall, 53% of patients achieved clinical parameters.
  • 58% of patients achieved ultrasound remission and 65% showed T-cell remission.
  • MDR was observed in 35% of patients and was associated with the best (lower) PRO scores compared with the other definitions of remission.

Citation:

Gul HL, et al. Defining remission in rheumatoid arthritis: Does it matter to the patient? A comparison of multi-dimensional remission criteria and patient reported outcomes. [Published online ahead of print August 19, 2019]. Rheumatology. doi:10.1093/rheumatology/kez330.

Commentary:

Treatment of RA to an objective target of remission or low disease activity is widely accepted as standard of care. Commonly used disease activity scores, including CDAI and DAS28, are composites that include both subjective and objective components as well as patient global self-evaluation which may not fully encompass the burden of RA symptoms. The current study examines the concept of multi-dimensional remission (MDR) using clinical, radiologic, and serologic scores to define remission and correlate to PROMs. Of note, T cell subset typing is not a standard remission criterion, though the authors suggest that induction of remission is predicted by normalization of certain T cell subsets. This composite MDR remission score was noted to be heterogeneous with differences in clinical, radiologic, and T cell scores based on disease duration, seropositivity, and treatment naivety. MDR remission correlated well to PROMs including HAQ, global health, and pain and fatigue scales. Whether MDR remission is a better composite than commonly used scores bears further exploration as the combination is more cumbersome to use in routine clinical practice. —Arundathi Jayatilleke, MD