Remission or Not Remission, That's the Question: Shedding Light on Remission and the Impact of Objective and Subjective Measures Reflecting Disease Activity in Rheumatoid Arthritis.

introductionThe inclusion of certain variables in remission formulas for rheumatoid arthritis (RA) may give rise to discrepancies. An increase in patient global assessment (PGA), a variable showing the patient's self-evaluation of their disease activity, may alone tilt a patient out of remission when using certain remission-assessing methods. This study aimed to explore differences in remission rates among various formulas and the impact of PGA and other clinical variables on the calculation of remission.

methodsData were collected from RA patients monitored during the years 2015-2019 at an outpatient clinic in southern Norway. Linear and logistic regression assessed associations between PGA, other RA-related variables, and remission-assessing methods.

resultsRemission rates were 23%, 65%, and 73% in 2019 when assessing the same 502 RA patients using Boolean remission, Boolean remission without PGA, and the disease activity score (DAS) with C-reactive peptide [DAS28(3)-CRP] method, respectively. Among the same population that year, 27% reported PGA ≤ 10, 74% had a tender joint count of ≤ 1, 85% had a swollen joint count of ≤ 1, and 86% had CRP ≤ 10. Pain (standardized coefficient β = 0.7, p < 0.001) was most strongly associated with PGA. Pain, fatigue, and morning stiffness were substantially associated with the remission-assessing methods that incorporated PGA.

conclusionsSince PGA is strongly associated with the patient's perception of pain and may not reflect the inflammatory process, our study challenges the application of remission-assessing methods containing PGA when monitoring RA patients in the outpatient clinic. We recommend using measures that are less likely to be associated with noninflammatory pain and psychosocial factors.