New rheumatoid arthritis remission definitions were announced by the American College of Rheumatology. It's an update of the 1981 definition.
Why Change Definition of Remission Now?
Biologic drugs, which first came on the scene in 1998, have made remission attainable -- in a way it had never been before. The treatment advances were not in line, though, with the old definition of remission which had been created in 1981 by the American College of Rheumatology (ACR).
Not only will the new remission definition give researchers clearer standards in clinical trials, it gives patients the sense that they can achieve remission and lets them understand when that occurs.
In 1981, remission was defined as elimination of all disease. The new definitions for remission are more realistic and more specific.
The New Rheumatoid Arthritis Remission Definition
The American College of Rheumatology and European League Against Rheumatism analyzed clinical trial data and surveyed committee members before coming up with two definitions of rheumatoid arthritis remission.
Definition 1
To be considered in remission, a clinical trial participant would need to have:
- Tender joint count - less than or equal to 1
- Swollen joint count - less than or equal to 1
- C-reactive protein - less than or equal to 1 mg/dl
- Patient global assessment score - less than or equal to 1 on a 0 to 10 scale
Definition 2
Uses the Simplified Disease Activity Index, which includes the 4 criteria above plus a physician global assessment, added together. Scale is from 0 to 10. Remission is less than or equal to 3.3.Patient global assessment is how the patient feels they are doing. A physician global assessment considers how the physician feels the patient is doing.
The Bottom Line
The next step is to see if the aforementioned definitions have application in clinical practice. The old American College of Rheumatology classification criteria (1981) for determining clinical remission include:
- morning stiffness less than or equal to 15 minutes
- no fatigue
- no joint pain
- no joint tenderness or pain on motion
- no soft tissue swelling in joints or tendon sheaths
- erythrocyte sedimentation rate (a blood test which measures inflammation) less than or equal to 30 in females and 20 in males
Sources:
Rheumatoid Arthritis Researchers Redefine Remission. American College of Rheumatology. February 3, 2011.
http://www.rheumatology.org/practice/clinical/classification/ra/ra_remission_2011.asp
Preliminary Criteria for Clinical Remission in Arthritis. Arthritis and Rheumatism. Pinals RS et al., October 1981.
