ArticleAdvances in rheumatology (London, England)2026
Are global definitions enough? Revisiting CDAI and SDAI remission cut-offs in Brazilian Rheumatoid Arthritis patients.
Article in Advances in rheumatology (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRheumatoid arthritis (RA) is a chronic systemic inflammatory disease in which achieving remission is the most effective strategy to prevent progression and optimize long-term outcomes. The performance of commonly used disease activity indices has not been well validated in the Brazilian RA population. This study aimed to evaluate the agreement between CDAI/SDAI and the revised Boolean 2.0 remission criteria, which served as the reference standard, and to identify the most accurate CDAI and SDAI remission cut-offs in this population.
methodsWe conducted a cross-sectional analysis of baseline data from a Brazilian Cohort study, which included 840 patients from 11 public hospitals in Brazil. Disease activity was assessed using DAS28-CRP, DAS28-ESR, SDAI, CDAI, and Boolean 1.0/2.0. Agreement was assessed using Cohen’s kappa, and optimal remission cut-offs were determined through ROC curve analysis.
resultsThe study population was predominantly female (89.8%), with a mean age of 57 years and a median disease duration of 12 years. DAS28-CRP showed the highest remission rate (39.2%), whereas Boolean 1.0 showed the lowest (15.1%). Strong agreement was found between Boolean 2.0, and both the SDAI (κ = 0.775) and CDAI (κ = 0.692). ROC analysis revealed that the most accurate remission cut-offs were SDAI ≤ 4.3 and CDAI ≤ 3.9, which increased remission detection by 5.9% and 6.2%, respectively.
conclusionIn our cohort, SDAI ≤ 4.3 and CDAI ≤ 3.9 were the values most closely aligned with Boolean 2.0 remission. These adjusted cut-offs may help minimize overtreatment in resource-limited settings. Prospective studies assessing function, radiographic progression, and quality of life are warranted to confirm their validity in the Brazilian population.
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