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 Felson et al

Should quantitative assessment of rheumatoid arthritis include measures of joint damage and patient distress, in addition to measures of apparent inflammatory activity?

“…Recent controversies concerning patient global assessment (PATGL) in rheumatoid arthritis (RA) remission criteria ( 1 , 2 ) largely ignore issues that emerge when, as noted by Felson et al, “remission criteria designed and validated in clinical trials are applied to…help assess treatment ‘success’ in clinical practice…and could serve as a ‘treat‐to‐target’ goal” ( 1 ). All six RA core data measures and indices—including swollen joint count and tender joint count, as well as PATGL, Disease Activity Score in 28 (DAS 28) Joints, and other indices—are elevated significantly not only by inflammatory activity, but also by secondary osteoarthritis ( 3 , 4 , 5 ), depression ( 6 ), and/or fibromyalgia (FM) ( 7 , 8 ), regardless of levels of inflammatory activity (see Table 1 of representative reports).…”