title: Achievement of Remission and Low Disease Activity Definitions in Patients with Rheumatoid Arthritis in Clinical Practice: Results from the NOR-DMARD Study.
abstract: OBJECTIVE
  To examine the frequency of 6 definitions for remission and 4 definitions for low disease activity (LDA) after starting a disease-modifying antirheumatic drug (DMARD) in patients with rheumatoid arthritis (RA) in clinical practice, and to study whether predictors for achieving remission after 6 months are similar for these definitions.
  
  
  METHODS
  Remission and LDA were calculated according to the 28-joint Disease Activity Score (DAS28), the Clinical Disease Activity Index (CDAI), the Simplified Disease Activity Index (SDAI), the Routine Assessment of Patient Index Data (RAPID3), and both the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission definitions 3 and 6 months after 4992 DMARD prescriptions for patients enrolled in the NOR-DMARD, a 5-center Norwegian register. Prediction of remission after 6 months was also studied.
  
  
  RESULTS
  After 3 months, remission rates varied between definitions from 8.7% to 22.5% and for LDA from 35.5% to 42.7%, and increased slightly until 6 months of followup. DAS28 and RAPID3 gave the highest and ACR/EULAR, SDAI, and CDAI the lowest proportions for remission. Positive predictors for remission after 6 months were similar across the definitions and included lower age, male sex, short disease duration, high level of education, current nonsmoking, nonerosive disease, treatment with a biological DMARD, being DMARD-naive, good physical function, little fatigue, and LDA.
  
  
  CONCLUSIONS
  In daily clinical practice, the DAS28 and RAPID3 definitions identified remission about twice as often as the ACR/EULAR Boolean, SDAI, and CDAI. Predictors of remission were similar across remission definitions. These findings provide additional evidence to follow treatment recommendations and treat RA early with a DMARD.
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Buskerud Central Hospital, Drammen; Department of Rheumatology, St. Olavs Hospital, Trondheim; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.T. Uhlig, MD, Professor, Chief Consultant, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; E. Lie, MD, PhD, Fellow, Department of Rheumatology, Diakonhjemmet Hospital; V. Norvang, MD, Intern, Department of Rheumatology, Diakonhjemmet Hospital; Å.S. Lexberg, MD, Consultant, Department of Rheumatology, Buskerud Central Hospital; E. Rødevand, MD, Head of Department, Department of Rheumatology, St. Olavs Hospital; F. Krøll, MD, Head of Department, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; S. Kalstad, MD, Head of Department, Department of Rheumatology, University Hospital of Northern Norway, University Hospital of Northern Norway; I.C. Olsen, MSc, PhD, Senior Researcher, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, Professor, Head of Department, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo. tillmann.uhlig@medisin.uio.no.
authors.forename: Till
authors.initials: T
authors.lastname: Uhlig
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Buskerud Central Hospital, Drammen; Department of Rheumatology, St. Olavs Hospital, Trondheim; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.T. Uhlig, MD, Professor, Chief Consultant, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; E. Lie, MD, PhD, Fellow, Department of Rheumatology, Diakonhjemmet Hospital; V. Norvang, MD, Intern, Department of Rheumatology, Diakonhjemmet Hospital; Å.S. Lexberg, MD, Consultant, Department of Rheumatology, Buskerud Central Hospital; E. Rødevand, MD, Head of Department, Department of Rheumatology, St. Olavs Hospital; F. Krøll, MD, Head of Department, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; S. Kalstad, MD, Head of Department, Department of Rheumatology, University Hospital of Northern Norway, University Hospital of Northern Norway; I.C. Olsen, MSc, PhD, Senior Researcher, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, Professor, Head of Department, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lie
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Buskerud Central Hospital, Drammen; Department of Rheumatology, St. Olavs Hospital, Trondheim; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.T. Uhlig, MD, Professor, Chief Consultant, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; E. Lie, MD, PhD, Fellow, Department of Rheumatology, Diakonhjemmet Hospital; V. Norvang, MD, Intern, Department of Rheumatology, Diakonhjemmet Hospital; Å.S. Lexberg, MD, Consultant, Department of Rheumatology, Buskerud Central Hospital; E. Rødevand, MD, Head of Department, Department of Rheumatology, St. Olavs Hospital; F. Krøll, MD, Head of Department, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; S. Kalstad, MD, Head of Department, Department of Rheumatology, University Hospital of Northern Norway, University Hospital of Northern Norway; I.C. Olsen, MSc, PhD, Senior Researcher, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, Professor, Head of Department, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Norvang
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Buskerud Central Hospital, Drammen; Department of Rheumatology, St. Olavs Hospital, Trondheim; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.T. Uhlig, MD, Professor, Chief Consultant, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; E. Lie, MD, PhD, Fellow, Department of Rheumatology, Diakonhjemmet Hospital; V. Norvang, MD, Intern, Department of Rheumatology, Diakonhjemmet Hospital; Å.S. Lexberg, MD, Consultant, Department of Rheumatology, Buskerud Central Hospital; E. Rødevand, MD, Head of Department, Department of Rheumatology, St. Olavs Hospital; F. Krøll, MD, Head of Department, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; S. Kalstad, MD, Head of Department, Department of Rheumatology, University Hospital of Northern Norway, University Hospital of Northern Norway; I.C. Olsen, MSc, PhD, Senior Researcher, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, Professor, Head of Department, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo.
authors.forename: Åse Stavland
authors.initials: ÅS
authors.lastname: Lexberg
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Buskerud Central Hospital, Drammen; Department of Rheumatology, St. Olavs Hospital, Trondheim; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.T. Uhlig, MD, Professor, Chief Consultant, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; E. Lie, MD, PhD, Fellow, Department of Rheumatology, Diakonhjemmet Hospital; V. Norvang, MD, Intern, Department of Rheumatology, Diakonhjemmet Hospital; Å.S. Lexberg, MD, Consultant, Department of Rheumatology, Buskerud Central Hospital; E. Rødevand, MD, Head of Department, Department of Rheumatology, St. Olavs Hospital; F. Krøll, MD, Head of Department, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; S. Kalstad, MD, Head of Department, Department of Rheumatology, University Hospital of Northern Norway, University Hospital of Northern Norway; I.C. Olsen, MSc, PhD, Senior Researcher, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, Professor, Head of Department, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo.
authors.forename: Erik
authors.initials: E
authors.lastname: Rødevand
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Buskerud Central Hospital, Drammen; Department of Rheumatology, St. Olavs Hospital, Trondheim; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.T. Uhlig, MD, Professor, Chief Consultant, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; E. Lie, MD, PhD, Fellow, Department of Rheumatology, Diakonhjemmet Hospital; V. Norvang, MD, Intern, Department of Rheumatology, Diakonhjemmet Hospital; Å.S. Lexberg, MD, Consultant, Department of Rheumatology, Buskerud Central Hospital; E. Rødevand, MD, Head of Department, Department of Rheumatology, St. Olavs Hospital; F. Krøll, MD, Head of Department, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; S. Kalstad, MD, Head of Department, Department of Rheumatology, University Hospital of Northern Norway, University Hospital of Northern Norway; I.C. Olsen, MSc, PhD, Senior Researcher, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, Professor, Head of Department, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo.
authors.forename: Frode
authors.initials: F
authors.lastname: Krøll
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Buskerud Central Hospital, Drammen; Department of Rheumatology, St. Olavs Hospital, Trondheim; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.T. Uhlig, MD, Professor, Chief Consultant, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; E. Lie, MD, PhD, Fellow, Department of Rheumatology, Diakonhjemmet Hospital; V. Norvang, MD, Intern, Department of Rheumatology, Diakonhjemmet Hospital; Å.S. Lexberg, MD, Consultant, Department of Rheumatology, Buskerud Central Hospital; E. Rødevand, MD, Head of Department, Department of Rheumatology, St. Olavs Hospital; F. Krøll, MD, Head of Department, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; S. Kalstad, MD, Head of Department, Department of Rheumatology, University Hospital of Northern Norway, University Hospital of Northern Norway; I.C. Olsen, MSc, PhD, Senior Researcher, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, Professor, Head of Department, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo.
authors.forename: Synøve
authors.initials: S
authors.lastname: Kalstad
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Buskerud Central Hospital, Drammen; Department of Rheumatology, St. Olavs Hospital, Trondheim; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.T. Uhlig, MD, Professor, Chief Consultant, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; E. Lie, MD, PhD, Fellow, Department of Rheumatology, Diakonhjemmet Hospital; V. Norvang, MD, Intern, Department of Rheumatology, Diakonhjemmet Hospital; Å.S. Lexberg, MD, Consultant, Department of Rheumatology, Buskerud Central Hospital; E. Rødevand, MD, Head of Department, Department of Rheumatology, St. Olavs Hospital; F. Krøll, MD, Head of Department, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; S. Kalstad, MD, Head of Department, Department of Rheumatology, University Hospital of Northern Norway, University Hospital of Northern Norway; I.C. Olsen, MSc, PhD, Senior Researcher, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, Professor, Head of Department, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo.
authors.forename: Inge C
authors.initials: IC
authors.lastname: Olsen
authors.affiliation: From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Buskerud Central Hospital, Drammen; Department of Rheumatology, St. Olavs Hospital, Trondheim; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.T. Uhlig, MD, Professor, Chief Consultant, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; E. Lie, MD, PhD, Fellow, Department of Rheumatology, Diakonhjemmet Hospital; V. Norvang, MD, Intern, Department of Rheumatology, Diakonhjemmet Hospital; Å.S. Lexberg, MD, Consultant, Department of Rheumatology, Buskerud Central Hospital; E. Rødevand, MD, Head of Department, Department of Rheumatology, St. Olavs Hospital; F. Krøll, MD, Head of Department, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; S. Kalstad, MD, Head of Department, Department of Rheumatology, University Hospital of Northern Norway, University Hospital of Northern Norway; I.C. Olsen, MSc, PhD, Senior Researcher, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, Professor, Head of Department, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D012042:Registries; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: LOW DISEASE ACTIVITY; PREDICTION; REMISSION; RHEUMATOID ARTHRITIS