title: Comparison of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.
abstract: BACKGROUND
  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.
authors.forename: Emese
authors.initials: E
authors.lastname: Balogh
authors.forename: Joao
authors.initials: J
authors.lastname: Madruga Dias
authors.forename: Carl
authors.initials: C
authors.lastname: Orr
authors.forename: Ronan
authors.initials: R
authors.lastname: Mullan
authors.forename: Len
authors.initials: L
authors.lastname: Harty
authors.forename: Oliver
authors.initials: O
authors.lastname: FitzGerald
authors.forename: Phil
authors.initials: P
authors.lastname: Gallagher
authors.forename: Miriam
authors.initials: M
authors.lastname: Molloy
authors.forename: Eileen
authors.initials: E
authors.lastname: O'Flynn
authors.forename: Alexia
authors.initials: A
authors.lastname: Kelly
authors.forename: Patricia
authors.initials: P
authors.lastname: Minnock
authors.forename: Madeline
authors.initials: M
authors.lastname: O'Neill
authors.forename: Louise
authors.initials: L
authors.lastname: Moore
authors.forename: Mairead
authors.initials: M
authors.lastname: Murray
authors.forename: Ursula
authors.initials: U
authors.lastname: Fearon
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Veale
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein