title: The effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.
abstract: OBJECTIVE
  Predictors of remission in rheumatoid arthritis (RA) have been defined in cross-sectional analyses using the 28-joint Disease Activity Score (DAS28), but not with newer composite disease activity measures or using the more clinically relevant state of sustained remission. We have evaluated predictors of remission using cross-sectional and longitudinal durations of disease state, and by applying additional definitions of remission [American College of Rheumatology/European League Against Rheumatism Boolean, Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI)].
  
  
  METHODS
  Individuals in the Alberta Biologics Pharmacosurveillance Program were classified for the presence of remission (point and/or sustained > 1 yr) by each of the 4 definitions. Multivariate models were constructed including all available variables in the dataset and refined to optimize model fit and predictive ability to calculate OR for remission.
  
  
  RESULTS
  Nonsmoking status independently predicted point remission by all definitions (OR range 1.20-2.71). Minority ethnicity decreased odds of remission by DAS28 (OR 0.13) and CDAI (OR 0.09) definitions. Male sex was associated with DAS28 remission (OR 2.85), whereas higher baseline physician global (OR 0.67) and erythrocyte sedimentation rate values (OR 0.98) decreased odds of DAS28 remission. Higher baseline patient global score (OR 0.77) and swollen joint counts (OR 0.93) were negative predictors for CDAI remission. Higher baseline Health Assessment Questionnaire (OR 0.62) reduced odds for remission by the SDAI definition, and educational attainment increased these odds (OR 2.13). Sustained remission was negatively predicted by baseline physician global for the DAS28 (OR 0.80), and higher tender joint count (OR 0.96) for the CDAI.
  
  
  CONCLUSIONS
  We demonstrate the influence of duration of remission state and remission definition on defining independent predictors for remission in RA requiring anti-tumor necrosis factor therapy. These predictors offer improved applicability for modern rheumatology practice.
authors.affiliation: From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Barnabe
authors.affiliation: From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta.
authors.forename: Joanne
authors.initials: J
authors.lastname: Homik
authors.affiliation: From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Barr
authors.affiliation: From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta.
authors.forename: Liam
authors.initials: L
authors.lastname: Martin
authors.affiliation: From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Maksymowych
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012074:Remission Induction; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: PREDICTORS OF RESPONSE; REMISSION; RHEUMATOID ARTHRITIS