Open Access Research article

Comparison of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder

Emese Balogh12, Joao Madruga Dias1, Carl Orr1, Ronan Mullan1, Len Harty1, Oliver FitzGerald1, Phil Gallagher1, Miriam Molloy1, Eileen O’Flynn1, Alexia Kelly1, Patricia Minnock1, Madeline O’Neill1, Louise Moore1, Mairead Murray1, Ursula Fearon1 and Douglas J Veale1*

Author Affiliations

1 Dublin Academic Medical Centre, Department of Rheumatology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

2 Department of Rheumatology, University of Debrecen Medical and Health Science Center, 98 Nagyerdei krt., Debrecen, Hungary

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Arthritis Research & Therapy 2013, 15:R221  doi:10.1186/ar4421

Published: 24 December 2013

Abstract

Introduction

Our objectives were to assess the frequency and sustainability of American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) and Disease Activity Score (DAS)28(4v)–C-reactive protein (CRP) remission 12 months after the initiation of tumour necrosis factor inhibitor (TNFi) therapy in a rheumatoid arthritis (RA) cohort.

Methods

Data were collected of 273 biologic naive RA patients at baseline, then 3, 6 and 12 months post-TNFi therapy. Remission status was calculated using DAS28(4v)-CRP <2.6 and ACR/EULAR Boolean criteria. Response was scored using EULAR criteria.

Results

Mean (range) patient age was 59.9 (7.2-85.4) years with disease duration of 13.4 (1.0-52.0) years. Responder status maintained from 3–12 months (86%, 82.4%), laboratory/clinical parameters (erythrocyte sedimentation rate (ESR), CRP, patient global health (PGH), DAS28(4v)-CRP) also showed sustained improvement (P < 0.05). DAS28 remission was reached by 102 subjects at 1 year, 27 patients were in Boolean remission, but 75 missed it from the DAS28 remission group. Patients in remission were younger (P = 0.041) with lower baseline tender joint count (TJC)28 and PGH than those not in remission (P = 0.001, P = 0.047). DAS28 remission patients were older (P = 0.026) with higher 12 months PGH and subsequently higher DAS28 than Boolean remission patients (P < 0.0001). Patients not achieving Boolean remission due to missing one subcriteria most frequently missed PGH ≤1 criteria (79.8%).

Conclusions

Only 10% of this TNFi treated cohort achieved remission according to the new ACR/EULAR criteria, which requires lower disease activity. More stringent criteria may ensure further resolution of disease activity and better longterm radiographic outcome, which supports earlier intervention with biologic therapy in RA.