Felson DT, Smolen JS, Wells G et al.; American College of Rheumatology; European League Against Rheumatism. Arthritis Rheum 2011;63:573–86.
In clinical practice, the goal of treatment for rheumatoid arthritis used to be “a state of low disease activity (LDA)”, based on the data showing that patients who achieve a state of LDA have better functional outcomes. With the advent of new therapeutics, remission has increasingly been considered the goal of treatment. To this end, it has been necessary to develop new definitions of remission. This article describes new provisional definitions of remission, proposed by the American College of Rheumatology and European League Against Rheumatism. In brief, for clinical practice, the definition of ≤1 tender or swollen joint, no acute phase reactants, and a patient that feels well, seems the most practical.
A committee consisting of American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) members, all experts from different backgrounds, reviewed different analyses from rheumatoid arthritis (RA) clinical trials in which stringent definitions of remission had been included. Core set measures such as joint counts and levels of an acute phase reactant were used to define remission. To select a specific definition of remission, trial data were analyzed in order to examine the candidate measures that predicted good radiographic and functional outcomes. The analyses suggested that inclusion of a patient-reported measure had an added contribution.