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Remission in rheumatoid arthritis by different criteria does not converge over the inflammatory markers
Author(s) -
Chandrashekara S.,
Priyanka B. U.
Publication year - 2013
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12091
Subject(s) - medicine , erythrocyte sedimentation rate , rheumatoid arthritis , c reactive protein , complete remission , gastroenterology , arthritis , inflammation , chemotherapy
Objective Remission is an ideal target in the management of rheumatoid arthritis ( RA ). We compared A merican C ollege of R heumatology ( ACR ) 1981 preliminary definition of remission, E uropean L eague A gainst R heumatism ( EULAR ) disease activity score of 28 joints – C ‐reactive protein ( DAS 28 (3)‐ CRP ) and DAS 28 (3)‐ ESR (erythrocyte sedimentation rate) and newer ACR / EULAR remission criteria from 2011. We assessed the agreement between these definitions using kappa statistics in a real‐time clinical scenario. Materials and methods This is a cross sectional study in which 460 patients' charts were reviewed. Their data on tender and swollen joint counts, visual analogue scale of patient global assessment ( P t GA ), ESR and CRP were retrieved. One hundred patients who fulfilled one of the remission criteria and had all the required five variables were selected and they were categorized into remission using all the four definitions. Results Only one case out of 100 fulfilled all four remission criteria. Among 100 cases: ACR 1981 classified six in remission; ACR / EULAR 2011, eight; DAS 28 (3)‐ ESR , 24; and DAS 28 (3)‐ CRP classified 100 patients in remission. A substantial number of patients continued to have features suggesting persisting active inflammation, despite being categorized into remission. A major portion of disagreement was in ESR and CRP . The value spread of all clinical parameters such as swollen joint count, tender joint count and Pt GA had no significant difference in the patients classified as being in remission. Conclusion The DAS 28 (3)‐ CRP overestimated remission compared to all other criteria. Disagreement was more in laboratory inflammatory parameters. A uniform definition of remission is needed.