title: Signs of forefeet joint synovitis have a limited impact on patient's perception of rheumatoid arthritis disease activity and acute-phase reactants.
abstract: OBJECTIVE
  To determine the prevalence and distribution of signs of synovitis in the residual joints in remission defined by the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria and the role of their components in preventing misclassification due to reduced joint count.
  
  
  METHODS
  The cross-sectional observational data of RA patients including full joint counts were analyzed. Definitions of remission used were the ACR/EULAR RA remission criteria and their modifications using full joint counts with the same thresholds of the items and the calculated results.
  
  
  RESULTS
  A total of 304 RA patients with 3,149 observations could be analyzed. Patients in remission according to the ACR/EULAR remission criteria can still show residual disease activity in the feet in up to 27% of the population with a 28-joint count remission. Residual disease activity has no impact on patient's global assessment for current disease activity, when signs of concomitant ankle joint synovitis were absent.
  
  
  CONCLUSIONS
  RA patients in remission according to the ACR/EULAR definitions can still show signs of synovitis mostly in the forefeet joints. Acute-phase reactants and patient's global assessment for current disease activity have little impact in mitigating the limitation of reduced joint count.
authors.affiliation: a Division of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Hospital, and Department of Respiratory Medicine , Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences , Nagoya, Aichi , Japan.
authors.forename: Taio
authors.initials: T
authors.lastname: Naniwa
authors.affiliation: a Division of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Hospital, and Department of Respiratory Medicine , Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences , Nagoya, Aichi , Japan.
authors.forename: Shiho
authors.initials: S
authors.lastname: Iwagaitsu
authors.affiliation: a Division of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Hospital, and Department of Respiratory Medicine , Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences , Nagoya, Aichi , Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Tamechika
authors.affiliation: a Division of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Hospital, and Department of Respiratory Medicine , Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences , Nagoya, Aichi , Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Maeda
authors.affiliation: a Division of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Hospital, and Department of Respiratory Medicine , Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences , Nagoya, Aichi , Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Niimi
mesh_terms: D000209:Acute-Phase Proteins; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D003430:Cross-Sectional Studies; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D011859:Radiography; D012074:Remission Induction; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000188:drug therapy
chemical_list: D000209:Acute-Phase Proteins; D018501:Antirheumatic Agents
keywords: Acute-phase reactant; Metatarsophalangeal joint; Patient outcome assessment; Remission; Rheumatoid arthritis