Induction of remission in rheumatoid arthritis: criteria and opportunities.
The concept of remission in rheumatology is complicated by the lack of a single gold standard measurement, spontaneous remissions and the usage of several sets of remission criteria. Feasibility is reduced by traditional clinical practice, which does not include remission criteria monitoring. The "window of opportunity" to prevent joint damage with DMARD therapy lasts only a few months. The perspective of the physician and patient differ, as the former gives importance to signs of disease activity, whereas the latter to disability and quality of life. All patients with rheumatoid arthritis are candidates for combination DMARD-based therapy, which should be instituted without delay. Remission is important to prevent joint destruction, preserve adequate quality of life and prevent disability. The introduction of biological agents has made this objective feasible, but the failure rate is still high (about 50%), on account of lack of response, contraindications and intolerance.
Valesini
Guido
G
Dipartimento di Clinica e Terapia Medica, Reumatologia, Sapienza, Università di Roma, Policlinico Umberto I, 00161, Rome, Italy. guido.valesini@uniroma1.it
Di Franco
Manuela
M
Spinelli
Francesca Romana
FR
Scrivo
Rossana
R
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D004185:Disability Evaluation; D004359:Drug Therapy, Combination; D006801:Humans; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents