title: Discordance between tender and swollen joint count as well as patient's and evaluator's global assessment may reduce likelihood of remission in patients with rheumatoid arthritis and psoriatic arthritis: data from the prospective multicentre NOR-DMARD study.
abstract: OBJECTIVE
  To investigate the predictive value of discordance between (1) tender and swollen joint count and (2) patient's and evaluator's global assessment on remission in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).
  
  
  METHODS
  From the prospective, multicentre Norwegian-Disease-Modifying Antirheumatic Drug study, we included patients with RA and PsA starting first-time tumour necrosis factor inhibitors and DMARD-naïve patients starting methotrexate between 2000 and 2012. The predictive value of ΔTSJ (tender minus swollen joint counts) and ΔPEG (patient's minus evaluator's global assessment) on remission was explored in prespecified logistic regression models adjusted for age, sex, disease duration and smoking.
  
  
  RESULTS
  A total of 2735 patients with RA and 1236 patients with PsA were included (mean (SD) age 55.0 (13.5)/48.3 (12.4) years, median(range) disease duration 0.7 (0.0-58.0)/1.3 (0.0-48.3) years, 69.7/48.4% females). Baseline ΔTSJ/ΔPEG reduced the likelihood of achieving DAS28<2.6, SDAI≤3.3, CDAI≤2.8, ACR/EULAR Boolean and DAPSA<4 remission after 3 and 6 months in RA (OR 0.95-0.97, p<0.001/OR 0.96-0.99, p≤0.01) and PsA (OR 0.91-0.94, p≤0.004/OR 0.89-0.99, p≤0.002), except for ΔPEG and 6-month DAS28 remission in PsA.
  
  
  CONCLUSIONS
  Discordance between patient's and physician's evaluation of disease activity reflected through ΔTSJ and partly ΔPEG may reduce likelihood of remission in RA and PsA. The findings are relevant for use of the treat-to-target strategy in individual patients.
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.|Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Michelsen
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Eirik Klami
authors.initials: EK
authors.lastname: Kristianslund
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Hilde Berner
authors.initials: HB
authors.lastname: Hammer
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Karen Minde
authors.initials: KM
authors.lastname: Fagerli
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lie
authors.affiliation: Department of Rheumatology, Vestre Viken/Drammen Hospital, Drammen, Norway.
authors.forename: Ada
authors.initials: A
authors.lastname: Wierød
authors.affiliation: Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.
authors.forename: Synøve
authors.initials: S
authors.lastname: Kalstad
authors.affiliation: Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Rødevand
authors.affiliation: Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway.
authors.forename: Frode
authors.initials: F
authors.lastname: Krøll
authors.affiliation: Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway.|Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Glenn
authors.initials: G
authors.lastname: Haugeberg
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D018771:Arthralgia / Q000209:etiology*; D015535:Arthritis, Psoriatic / Q000150:complications / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D059026:Diagnostic Self Evaluation; D004185:Disability Evaluation; D004487:Edema / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009664:Norway; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D012074:Remission Induction; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate
keywords: Disease Activity; Psoriatic Arthritis; Rheumatoid Arthritis; Treatment