title: American College of Rheumatology/European League Against Rheumatism remission criteria for rheumatoid arthritis maintain reliable performance when evaluated in 44 joints.
abstract: OBJECTIVE
  To investigate the performance of the new remission criteria for rheumatoid arthritis (RA) in daily clinical practice and the effect of possible misclassification of remission when 44 joints are assessed.
  
  
  METHODS
  Disease activity and remission rate were calculated according to the Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and a Boolean-based definition for 1402 patients with RA in Keio University Hospital. Characteristics of patients in remission were investigated, and the number of misclassified patients was determined--those classified as being in remission based on 28-joint count but as nonremission based on a 44-joint count for each definition criterion.
  
  
  RESULTS
  Of all patients analyzed, 46.6%, 45.9%, 41.0%, and 31.5% were classified as in remission in the DAS28, SDAI, CDAI, and Boolean definitions, respectively. Patients classified into remission based only on the DAS28 showed relatively low erythrocyte sedimentation rates but greater swollen joint counts than those classified into remission based on the other definitions. In patients classified into remission based only on the Boolean criteria, the mean physician global assessment was greater than the mean patient global assessment. Although 119 patients had ≤ 1 involved joint in the 28-joint count but > 1 in the 44-joint count, only 34 of these 119 (2.4% of all subjects) were found to have been misclassified into remission.
  
  
  CONCLUSIONS
  In practice, about half of patients with RA can achieve clinical remission within the DAS28, SDAI, and CDAI; and one-third according to the Boolean-based definition. Patients classified in remission based on a 28-joint count may have pain and swelling in the feet, but misclassification of remission was relatively rare and was seen in only 2.4% of patients under a Boolean definition. The 28-joint count can be sufficient for assessing clinical remission based on the new remission criteria.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan. ykaneko@z6.keio.jp
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Harumi
authors.initials: H
authors.lastname: Kondo
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takeuchi
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism; D001799:Blood Sedimentation; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005060:Europe; D005260:Female; D006801:Humans; D007596:Joints / Q000503:physiopathology*; D008297:Male; D019278:Matrix Metalloproteinase 3 / Q000378:metabolism; D008875:Middle Aged; D012074:Remission Induction; D015203:Reproducibility of Results; D012219:Rheumatology / Q000592:standards*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
chemical_list: D018501:Antirheumatic Agents; D019278:Matrix Metalloproteinase 3
keywords: 44 JOINTS; REMISSION CRITERIA; RHEUMATOID ARTHRITIS; VERIFICATION