Correspondence on ‘Re-examining remission definitions in rheumatoid arthritis: considering the 28-joint Disease Activity Score, C reactive protein level and patient global assessment’

Ferreira, Ricardo; Welsing, Paco M J; Jacobs, Johannes W. G.; Gossec, Laure; Ndosi, Mwidimi; Machado, Pedro; Heijde, Desirée van der; Silva, José António Pereira da

doi:10.1136/annrheumdis-2021-221917

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…We read with interest the communication by Ferreira and colleagues on our editorial about the measurement of remission in rheumatoid arthritis 1. They agree with large parts of our editorial, particularly the importance of including patient-reported outcomes (PROs) in the evaluation of rheumatoid arthritis (RA) disease activity.…”

mentioning

confidence: 65%

Response to: Correspondence on ‘Re-examining remission definitions in rheumatoid arthritis: considering the 28-Joint Disease Activity Score, C-reactive protein level and patient global assessment’ by Ferreiraet al

Felson

Lacaille

LaValley³

et al. 2022

Ann Rheum Dis

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mentioning

confidence: 65%

Response to: Correspondence on ‘Re-examining remission definitions in rheumatoid arthritis: considering the 28-Joint Disease Activity Score, C-reactive protein level and patient global assessment’ by Ferreiraet al

Felson

Lacaille

LaValley³

et al. 2022

Ann Rheum Dis

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“…For TNFi and rituximab (that are more often used as second, third or more DMARD) the observed proportions were more in keeping with those reported from previous studies (eg, as compiled in). 35 The protocol-driven Norwegian RA data collections (the ARCTIC trial) had treatment outcomes superior to those cohorts reflective of treatment decisions as in clinical practice. Whether this reflects the advantage of protocol-based treat-to-target strategies, selection of patients into clinical trials, or both, remains unclear and beyond the scope of this study.…”

Section: Discussionmentioning

confidence: 99%

Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts

Westerlind,

Glintborg,

Hammer

et al. 2023

RMD Open

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ObjectivePrecision medicine in rheumatoid arthritis (RA) requires a good understanding of treatment outcomes and often collaborative efforts that call for data harmonisation. We aimed to describe how harmonisation across study cohorts can be achieved and investigate how the observed proportions reaching remission vary across remission criteria, study types, disease-modifying antirheumatic drugs (DMARDs) and countries, and how they relate to other treatment outcomes.MethodsWe used data from eight existing large-scale, clinical RA registers and a pragmatic trial from Sweden, Denmark and Norway. In these, we defined three types of treatment cohorts; methotrexate monotherapy (as first DMARD), tumour necrosis factor inhibitors (TNFi) (as first biological DMARD) and rituximab. We developed a harmonised study protocol defining time points during 36 months of follow-up, collected clinical visit data on treatment response, retention, persistence and six alternative definitions of remission, and investigated how these outcomes differed within and between cohorts, by treatment.ResultsCohort sizes ranged from ~50 to 22 000 patients with RA. The proportions reaching each outcome varied across outcome metric, but with small to modest variations within and between cohorts, countries and treatment. Retention and persistence rates were high (>50% at 1 year), yet <33% of patients starting methotrexate or TNFi, and only 10% starting rituximab, remained on drug without other DMARDs added and achieved American Congress of Rheumatology/European Alliance of Associations for Rheumatology or Simplified Disease Activity Index remission at 1 year.ConclusionHarmonisation of data from different RA data sources can be achieved without compromising internal validity or generalisability. The low proportions reaching remission, point to an unmet need for treatment optimisation in RA.

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“…Recent attention to elevated DAS28 in the absence of substantial inflammatory activity has focused primarily on PATGL and not the other 3 DAS28 components activity (16)(17)(18)(19). As a consequence, RA Boolean remission criteria have recently been revised for maximum PATGL from 1 to 2 (19).…”

Section: Discussionmentioning

confidence: 99%

“…In routine care, DAS28 and components may be elevated, independent of inflammatory activity, associated with comorbid depression (10)(11)(12)(13)(14), and fibromyalgia (FM) (15). Recent attention to elevated DAS28 in the absence of substantial inflammatory activity has focused primarily on PATGL (16)(17)(18)(19). RA Boolean remission criteria have been revised for maximum PATGL from 1 to 2 (19).…”

Section: Introductionmentioning

confidence: 99%

Elevated DAS28-ESR in patients with rheumatoid arthritis who have comorbid fibromyalgia is associated more with tender joint counts than with patient global assessment or swollen joint counts: implications for assessment of inflammatory activity

Kannayiram,

Schmukler,

et al. 2023

Clinical and Experimental Rheumatology

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Objective More than 20% of rheumatoid arthritis (RA) patients have comorbid fibromyalgia (FM+), which may elevate DAS28-ESR (disease activity score 28-erythrocyte sedimentation rate) and other indices, resulting in challenges to assess inflammatory disease activity. Although several reports indicate that elevated patient global assessment (PATGL) may elevate DAS28 in the absence of inflammatory activity, less information is available concerning the other three components, tender joint count (TJC), swollen joint count (SJC), and erythrocyte sedimentation rate (ESR), to possibly elevate DAS28 in FM+ vs. FM-RA patients.Methods A PubMed search identified 14 reports which presented comparisons of DAS28-ESR and its four components in RA FM+ vs. FM-groups. Median DAS28, component arithmetic differences, pooled effect sizes and 95% confidence intervals were analysed in the FM+ vs. FM-groups.

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Correspondence on ‘Re-examining remission definitions in rheumatoid arthritis: considering the 28-joint Disease Activity Score, C reactive protein level and patient global assessment’

Cited by 6 publications

References 15 publications

Response to: Correspondence on ‘Re-examining remission definitions in rheumatoid arthritis: considering the 28-Joint Disease Activity Score, C-reactive protein level and patient global assessment’ by Ferreiraet al

Response to: Correspondence on ‘Re-examining remission definitions in rheumatoid arthritis: considering the 28-Joint Disease Activity Score, C-reactive protein level and patient global assessment’ by Ferreiraet al

Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts

Elevated DAS28-ESR in patients with rheumatoid arthritis who have comorbid fibromyalgia is associated more with tender joint counts than with patient global assessment or swollen joint counts: implications for assessment of inflammatory activity

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