Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis.
Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician's clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Yoon Kyoung
http://orcid.org/0000-0001-6691-8939
YK
Sung
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Soo Kyung
http://orcid.org/0000-0003-4493-8837
SK
Cho
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Dam
http://orcid.org/0000-0002-3689-1226
D
Kim
Department of Rheumatology, Inje University Ilsan Paik Hospital, Goyang, Korea.
Bo Young
http://orcid.org/0000-0002-9635-4799
BY
Yoon
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Chan Bum
http://orcid.org/0000-0002-4691-5455
CB
Choi
Department of Rheumatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
Hoon Suk
http://orcid.org/0000-0001-5391-5376
HS
Cha
Department of Rheumatology, Catholic University of Daegu School of Medicine, Daegu, Korea.
Jung Yoon
http://orcid.org/0000-0003-0957-0395
JY
Choe
Department of Rheumatology, Dong-A University Hospital, Busan, Korea.
Won Tae
http://orcid.org/0000-0002-1585-1022
WT
Chung
Department of Rheumatology, Kyung Hee University Hospital, Seoul, Korea.
Seung Jae
http://orcid.org/0000-0002-9803-529X
SJ
Hong
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Jae Bum
http://orcid.org/0000-0002-0208-0505
JB
Jun
Department of Rheumatology, Kyungpook National University Hospital, Daegu, Korea.
Young Mo
http://orcid.org/0000-0002-7409-0729
YM
Kang
Department of Rheumatology, Jeju National University Hospital, Jeju, Korea.
Jinseok
http://orcid.org/0000-0001-7518-3284
J
Kim
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Tae Hwan
http://orcid.org/0000-0002-3542-2276
TH
Kim
Department of Rheumatology, Chonnam National University Hospital, Gwangju, Korea.
Tae Jong
http://orcid.org/0000-0002-2871-1635
TJ
Kim
Department of Rheumatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
Eunmi
http://orcid.org/0000-0002-6457-6792
E
Koh
Department of Rheumatology, Yeungnam University Hospital, Daegu, Korea.
Choong Ki
http://orcid.org/0000-0001-6820-8877
CK
Lee
Department of Rheumatology, Ewha Womans University Mokdong Hospital, Seoul, Korea.
Jisoo
http://orcid.org/0000-0001-6279-7025
J
Lee
Department of Rheumatology, Chonnam National University Hospital, Gwangju, Korea.
Shin Seok
http://orcid.org/0000-0001-6810-7355
SS
Lee
Department of Rheumatology, Dong-A University Hospital, Busan, Korea.
Sung Won
http://orcid.org/0000-0003-1213-1254
SW
Lee
Department of Rheumatology, Hanyang University Guri Hospital, Guri, Korea.
Hye Soon
http://orcid.org/0000-0002-8535-0442
HS
Lee
Department of Rheumatology, Kyung Hee University Hospital, Seoul, Korea.
Yeon Ah
http://orcid.org/0000-0001-9961-3947
YA
Lee
Department of Rheumatology, Catholic University of Daegu School of Medicine, Daegu, Korea.
Sung Hoon
http://orcid.org/0000-0002-3218-5420
SH
Park
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Dae Hyun
http://orcid.org/0000-0002-0643-4008
DH
Yoo
Department of Rheumatology, Chonbuk National University Hospital, Jeonju, Korea.
Wan Hee
http://orcid.org/0000-0002-8430-7629
WH
Yoo
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. scbae@hanyang.ac.kr.
Sang Cheol
http://orcid.org/0000-0003-4658-1093
SC
Bae
D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010820:Physicians; D012074:Remission Induction; D012217:Rheumatoid Factor / Q000032:analysis; D012720:Severity of Illness Index; D012737:Sex Factors
D018501:Antirheumatic Agents; D002097:C-Reactive Protein; D012217:Rheumatoid Factor
Arthritis, Rheumatoid; Discordance; Remission