Remission of rheumatoid arthritis in clinical practice: Application of the American College of Rheumatology/European League Against Rheumatism 2011 remission criteria

Shadi H. Shahouri, Kaleb D Michaud, Ted R Mikuls, Liron Caplan, Timothy S. Shaver, James D. Anderson, David N. Weidensaul, Ruth E. Busch, Shirley Wang, Frederick Wolfe

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Objective To describe use of the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria in clinical practice. Methods Remission was examined using data on 1,341 patients with RA (91% men) from the US Department of Veterans Affairs RA (VARA) registry (total of 9,700 visits) and 1,153 patients with RA (25.8% men) in a community rheumatology practice (Arthritis and Rheumatology Clinics of Kansas [ARCK]) (total of 6,362 visits). Cross-sectional and cumulative probabilities were studied, and agreement between the various remission criteria was assessed. Aspects of reliability of the criteria were determined using Boolean-based definitions, as well as the Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) scoring methods proposed by the ACR/EULAR joint committee. Results When the 3-variable ACR/EULAR definition of remission recommended for use in community practice (swollen and tender joint counts ≤1, and visual analog scale score for patient's global assessment of disease activity a;circ1) was applied, cross-sectional remission was 7.5% (95% confidence interval [95% CI] 6.4, 8.7%) for ARCK and 8.9% (95% CI 7.9, 9.9%) for VARA, and cumulative remission (remission at any observation) was 18.0% (for ARCK) and 24.4% (for VARA), over a mean followup of ∼2.2 years. Addition of the erythrocyte sedimentation rate or C-reactive protein level to the criteria set reduced remission to 5.0-6.2%, and use of the CDAI/SDAI increased the proportions to 6.9-10.1%. Moreover, 1.8-4.6% of the patients met remission criteria at ≥2 visits. Agreement between criteria definitions was good, as assessed by kappa statistics and Jaccard coefficients. Among patients in remission, the probability of a remission lasting 2 years was 6.0-14.1%. Among all patients, the probability of a remission lasting 2 years was <3%. Remission status and examination results for each patient varied substantially among physicians, as determined by multilevel analyses. Conclusion Cross-sectional remission occurred in 5.0-10.1% of the patients in these cohorts, with cumulative remission being 2-3 times greater; however, long-term remission was rare. Problems with reliability and agreement limit the usefulness of these criteria in the individual patient. However, the criteria can be an effective method for measuring clinical status and treatment effect in groups of patients in the community.

Original languageEnglish (US)
Pages (from-to)3204-3215
Number of pages12
JournalArthritis and rheumatism
Volume63
Issue number11
DOIs
StatePublished - Nov 1 2011

Fingerprint

Rheumatoid Arthritis
Rheumatology
Arthritis
Veterans
Rheumatic Diseases
Confidence Intervals
Multilevel Analysis
United States Department of Veterans Affairs
Blood Sedimentation
Visual Analog Scale
C-Reactive Protein
Registries
Research Design
Joints
Observation
Physicians

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Pharmacology (medical)

Cite this

Remission of rheumatoid arthritis in clinical practice : Application of the American College of Rheumatology/European League Against Rheumatism 2011 remission criteria. / Shahouri, Shadi H.; Michaud, Kaleb D; Mikuls, Ted R; Caplan, Liron; Shaver, Timothy S.; Anderson, James D.; Weidensaul, David N.; Busch, Ruth E.; Wang, Shirley; Wolfe, Frederick.

In: Arthritis and rheumatism, Vol. 63, No. 11, 01.11.2011, p. 3204-3215.

Research output: Contribution to journalArticle

Shahouri, Shadi H. ; Michaud, Kaleb D ; Mikuls, Ted R ; Caplan, Liron ; Shaver, Timothy S. ; Anderson, James D. ; Weidensaul, David N. ; Busch, Ruth E. ; Wang, Shirley ; Wolfe, Frederick. / Remission of rheumatoid arthritis in clinical practice : Application of the American College of Rheumatology/European League Against Rheumatism 2011 remission criteria. In: Arthritis and rheumatism. 2011 ; Vol. 63, No. 11. pp. 3204-3215.
@article{1ac208b0fcfc4ad4acb9e17b0c14b21e,
title = "Remission of rheumatoid arthritis in clinical practice: Application of the American College of Rheumatology/European League Against Rheumatism 2011 remission criteria",
abstract = "Objective To describe use of the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria in clinical practice. Methods Remission was examined using data on 1,341 patients with RA (91{\%} men) from the US Department of Veterans Affairs RA (VARA) registry (total of 9,700 visits) and 1,153 patients with RA (25.8{\%} men) in a community rheumatology practice (Arthritis and Rheumatology Clinics of Kansas [ARCK]) (total of 6,362 visits). Cross-sectional and cumulative probabilities were studied, and agreement between the various remission criteria was assessed. Aspects of reliability of the criteria were determined using Boolean-based definitions, as well as the Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) scoring methods proposed by the ACR/EULAR joint committee. Results When the 3-variable ACR/EULAR definition of remission recommended for use in community practice (swollen and tender joint counts ≤1, and visual analog scale score for patient's global assessment of disease activity a;circ1) was applied, cross-sectional remission was 7.5{\%} (95{\%} confidence interval [95{\%} CI] 6.4, 8.7{\%}) for ARCK and 8.9{\%} (95{\%} CI 7.9, 9.9{\%}) for VARA, and cumulative remission (remission at any observation) was 18.0{\%} (for ARCK) and 24.4{\%} (for VARA), over a mean followup of ∼2.2 years. Addition of the erythrocyte sedimentation rate or C-reactive protein level to the criteria set reduced remission to 5.0-6.2{\%}, and use of the CDAI/SDAI increased the proportions to 6.9-10.1{\%}. Moreover, 1.8-4.6{\%} of the patients met remission criteria at ≥2 visits. Agreement between criteria definitions was good, as assessed by kappa statistics and Jaccard coefficients. Among patients in remission, the probability of a remission lasting 2 years was 6.0-14.1{\%}. Among all patients, the probability of a remission lasting 2 years was <3{\%}. Remission status and examination results for each patient varied substantially among physicians, as determined by multilevel analyses. Conclusion Cross-sectional remission occurred in 5.0-10.1{\%} of the patients in these cohorts, with cumulative remission being 2-3 times greater; however, long-term remission was rare. Problems with reliability and agreement limit the usefulness of these criteria in the individual patient. However, the criteria can be an effective method for measuring clinical status and treatment effect in groups of patients in the community.",
author = "Shahouri, {Shadi H.} and Michaud, {Kaleb D} and Mikuls, {Ted R} and Liron Caplan and Shaver, {Timothy S.} and Anderson, {James D.} and Weidensaul, {David N.} and Busch, {Ruth E.} and Shirley Wang and Frederick Wolfe",
year = "2011",
month = "11",
day = "1",
doi = "10.1002/art.30524",
language = "English (US)",
volume = "63",
pages = "3204--3215",
journal = "Arthritis and Rheumatology",
issn = "2326-5191",
publisher = "John Wiley and Sons Ltd",
number = "11",

}

TY - JOUR

T1 - Remission of rheumatoid arthritis in clinical practice

T2 - Application of the American College of Rheumatology/European League Against Rheumatism 2011 remission criteria

AU - Shahouri, Shadi H.

AU - Michaud, Kaleb D

AU - Mikuls, Ted R

AU - Caplan, Liron

AU - Shaver, Timothy S.

AU - Anderson, James D.

AU - Weidensaul, David N.

AU - Busch, Ruth E.

AU - Wang, Shirley

AU - Wolfe, Frederick

PY - 2011/11/1

Y1 - 2011/11/1

N2 - Objective To describe use of the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria in clinical practice. Methods Remission was examined using data on 1,341 patients with RA (91% men) from the US Department of Veterans Affairs RA (VARA) registry (total of 9,700 visits) and 1,153 patients with RA (25.8% men) in a community rheumatology practice (Arthritis and Rheumatology Clinics of Kansas [ARCK]) (total of 6,362 visits). Cross-sectional and cumulative probabilities were studied, and agreement between the various remission criteria was assessed. Aspects of reliability of the criteria were determined using Boolean-based definitions, as well as the Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) scoring methods proposed by the ACR/EULAR joint committee. Results When the 3-variable ACR/EULAR definition of remission recommended for use in community practice (swollen and tender joint counts ≤1, and visual analog scale score for patient's global assessment of disease activity a;circ1) was applied, cross-sectional remission was 7.5% (95% confidence interval [95% CI] 6.4, 8.7%) for ARCK and 8.9% (95% CI 7.9, 9.9%) for VARA, and cumulative remission (remission at any observation) was 18.0% (for ARCK) and 24.4% (for VARA), over a mean followup of ∼2.2 years. Addition of the erythrocyte sedimentation rate or C-reactive protein level to the criteria set reduced remission to 5.0-6.2%, and use of the CDAI/SDAI increased the proportions to 6.9-10.1%. Moreover, 1.8-4.6% of the patients met remission criteria at ≥2 visits. Agreement between criteria definitions was good, as assessed by kappa statistics and Jaccard coefficients. Among patients in remission, the probability of a remission lasting 2 years was 6.0-14.1%. Among all patients, the probability of a remission lasting 2 years was <3%. Remission status and examination results for each patient varied substantially among physicians, as determined by multilevel analyses. Conclusion Cross-sectional remission occurred in 5.0-10.1% of the patients in these cohorts, with cumulative remission being 2-3 times greater; however, long-term remission was rare. Problems with reliability and agreement limit the usefulness of these criteria in the individual patient. However, the criteria can be an effective method for measuring clinical status and treatment effect in groups of patients in the community.

AB - Objective To describe use of the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria in clinical practice. Methods Remission was examined using data on 1,341 patients with RA (91% men) from the US Department of Veterans Affairs RA (VARA) registry (total of 9,700 visits) and 1,153 patients with RA (25.8% men) in a community rheumatology practice (Arthritis and Rheumatology Clinics of Kansas [ARCK]) (total of 6,362 visits). Cross-sectional and cumulative probabilities were studied, and agreement between the various remission criteria was assessed. Aspects of reliability of the criteria were determined using Boolean-based definitions, as well as the Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) scoring methods proposed by the ACR/EULAR joint committee. Results When the 3-variable ACR/EULAR definition of remission recommended for use in community practice (swollen and tender joint counts ≤1, and visual analog scale score for patient's global assessment of disease activity a;circ1) was applied, cross-sectional remission was 7.5% (95% confidence interval [95% CI] 6.4, 8.7%) for ARCK and 8.9% (95% CI 7.9, 9.9%) for VARA, and cumulative remission (remission at any observation) was 18.0% (for ARCK) and 24.4% (for VARA), over a mean followup of ∼2.2 years. Addition of the erythrocyte sedimentation rate or C-reactive protein level to the criteria set reduced remission to 5.0-6.2%, and use of the CDAI/SDAI increased the proportions to 6.9-10.1%. Moreover, 1.8-4.6% of the patients met remission criteria at ≥2 visits. Agreement between criteria definitions was good, as assessed by kappa statistics and Jaccard coefficients. Among patients in remission, the probability of a remission lasting 2 years was 6.0-14.1%. Among all patients, the probability of a remission lasting 2 years was <3%. Remission status and examination results for each patient varied substantially among physicians, as determined by multilevel analyses. Conclusion Cross-sectional remission occurred in 5.0-10.1% of the patients in these cohorts, with cumulative remission being 2-3 times greater; however, long-term remission was rare. Problems with reliability and agreement limit the usefulness of these criteria in the individual patient. However, the criteria can be an effective method for measuring clinical status and treatment effect in groups of patients in the community.

UR - http://www.scopus.com/inward/record.url?scp=80155128010&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80155128010&partnerID=8YFLogxK

U2 - 10.1002/art.30524

DO - 10.1002/art.30524

M3 - Article

C2 - 21739423

AN - SCOPUS:80155128010

VL - 63

SP - 3204

EP - 3215

JO - Arthritis and Rheumatology

JF - Arthritis and Rheumatology

SN - 2326-5191

IS - 11

ER -