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Objective  We aimed to standardize the definition of low disease activity in rheumatoid arthritis ( RA ) using the Outcome Measures in Rheumatology ( OMERACT ) group's proposed definition of minimal disease activity.    Method  Based on a nationwide  RA  database, we proposed new Boolean low disease activity criteria using  OMERACT 's core set definition of minimal disease activity that requires the fulfillment of at least five of the following seven core set measures: a pain score of 2 or less, a swollen joint count ( SJC 28) of 1 or fewer, a tender joint count of 1 or fewer, a Health Assessment Questionnaire score of 0.5 or less, a Physician's Global Assessment score of 1.5 or less, a Patient's Global Assessment score of 2 or less, and an erythrocyte sedimentation rate ( ESR ) of 20 mm/h or less. Using receiver operating characteristic analysis, we determined the cutoffs for the Simplified Disease Activity Index ( SDAI ), Clinical Disease Activity Index ( CDAI ), Routine Assessment of Patient Index Data 3 ( RAPID 3), and the Disease Activity Score in 28 joints ( DAS 28)– ESR .    Results  Of 8298 patients, 56.2% met the proposed Boolean low disease activity criteria. We determined an  SDAI  score of 5.5 or less and a  CDAI  score of 5 or less to be the new cutoffs, and we chose a  DAS 28 of 2.85 or less (the original cutoff for  DAS ‐based minimal disease activity) and a  RAPID 3 score of 6 or less (the original cutoff for RAPID3‐based low disease activity) with or without a swollen joint count ( SJC ) ( SJC  of 2 or fewer) as the cutoffs for  DAS 28 and  RAPID 3. The agreement between the new cutoffs for  DAS 28 of 2.85 or less vs.  CDAI  score of 5 or less,  CDAI  score of 5 or less vs.  RAPID 3 score of 6 or less (with  SJC  of 2 or fewer), and  DAS 28 of 2.85 or less vs.  RAPID 3 score of 6 or less (with  SJC  of 2 or fewer), was 0.619, 0.612 (0.702), and 0.474 (0.531), respectively.    Conclusion   OMERACT 's minimal disease activity definition may be used to standardize the criteria for low disease activity.

acr open rheumatology

A Proposal to Standardize Low Disease Activity Criteria in Rheumatoid Arthritis Based on the Outcome Measures in Rheumatology Minimal Disease Activity Definition