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Remission criteria for rheumatoid arthritis revised

The new criteria more uniformly identify the same patients in whom a remission of the disease can be detected.
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(Vienna, 19-01-2023) A research group led by Paul Studenic from the Department of Internal Medicine III at MedUni Vienna has revalidated the remission criteria for rheumatoid arthritis and adapted the definition according to Boolean. The researchers' study was published in the renowned journal "Annals of the Rheumatic Diseases".

More than ten years ago, a consortium with representatives from the American College of Rheumatology and the European Alliance of Associations for Rheumatology established temporary remission criteria. It is important that remission - i.e. the reduction of the disease - is defined as a state in which the disease is largely free of inflammation. This should be accompanied by a good health-related quality of life without an increase in structural or radiographic progression. The treatment goal must be agreed with the patient, but the therapy should be designed to bring the patient into remission. This is to minimise the risk of future deterioration.

In the course of the past years, there has been much criticism of the preliminary definition of remission. On one hand, because it could be too weak and the additional use of imaging measures (e.g. ultrasound remission) was propagated; on the other hand, because remission is defined too strictly and some patients receive "unnecessarily" strong therapy. A particular point of criticism was the component of the "Patient Global Assessment", the only patient-oriented target in the criteria. However, this PtGA is very sensitive to change. Potential alternatives have not yet been validated, which is why the PtGA should remain in the criteria.

New definition according to Boolean
Under the leadership of scientists at MedUni Vienna, preliminary work was carried out that showed that adapting the threshold value of the Patient Global Assessment (PtGA) from 1 to 2 is associated both with better harmonisation of the remission definitions and continues to produce good long-term outcomes. The task of the group of authors led by  first author Paul Studenic was to validate the preliminary remission criteria and adapt the definition according to Boolean, using data sets not previously used in this context. The updated criteria were endorsed by the two major professional societies.
Boolean remission requires that the number of swollen joints, the number of pressure painful joints and the C-reactive protein must be a maximum of 1 and the PtGA must now be a maximum of 2. The validation of the index-based remission criteria was done with a cut-off value for the Simplified Disease Activity Score of 3.3 and 2.8 for the Clinical Disease Activity Score. It showed that all definitions can now be better used interchangeably and the same patients can be classified as in remission or not with either definition. All are associated with good and stable long-term outcomes for these patients.

Rheumatoid arthritis is a chronic inflammatory disease characterised mainly by pain and swelling of the joints. It leads to significantly reduced quality of life, functionality and structural damage if not treated in time. Many therapies used today can sufficiently control this disease so that remission can also be established.

Annals of the Rheumatic Diseases
Arthritis & Rheumatology
American College of Rheumatology/EULAR remission criteria for rheumatoid arthritis: 2022 revision
Paul Studenic, Daniel Aletaha, Maarten de Wit, Tanja A Stamm, Farideh Alasti, Diane Lacaille, Josef S Smolen, David T Felson