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What is the definition of remission in RA?

What is the definition of remission in RA?. American Rheumatism Association (ARA)¹ Five or more of the following criteria must be fulfilled for at least two consecutive months: Duration of morning stiffness not exceeding 15 minutes No fatigue No joint pain (by history)

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What is the definition of remission in RA?

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  1. What is the definition of remission in RA? American Rheumatism Association (ARA)¹ • Five or more of the following criteria must be fulfilled for at least two consecutive months: • Duration of morning stiffness not exceeding 15 minutes • No fatigue • No joint pain (by history) • No joint tenderness or pain on motion • ESR (Westergren method): Female < 30 mm/h, Male < 20 mm/h DAS44² <1.6 DAS28² <2.6 CDAI³ < 2.8 1.Pinals RS, et al. Arthritis Rheum. 1981;24:1308-15. 2. Prevoo. Br J Rheumatol. 1996;35:1101-5. 3. Aletaha D, et al Arthritis Res Ther. 2005;7:R796-R806

  2. Remission in rheumatoid arthritis • Criteria for clinical remission RemissionLDA • Modified ACR criteria 4/5 (pain, TJ, SJ, MS,ESR) • DAS ≤ 1.6 ≤ 2.4 • DAS28 ≤ 2.6 ≤ 3.2 • SDAI (SJ+TJ+PGA+CRP) ≤ 3.3 ≤ 11 • CDAI (SJ+TJ+PGA) ≤ 2.8 ≤ 10 • Sustained remission • Imaging remission • MRI, US • Complete clinical response (FDA) : remission ≥ 6 months + radiographic arrest

  3. Remission is Heterogenous • Clinical Remission: ACR/DAS criteria, or normal acute phase response, no clinical synovitis • Imaging Remission: no significant synovitis on sensitive imaging • True Remission: a state of no detectable disease with no progression of structural damage

  4. Radiographic progression – Improvement with TNF Targeted Therapies (TEMPO) Total sharp score change over 3 years 6 MTX ETN ETN + MTX 4 Change from baseline (mean ± SD) * 2 * * 0 †‡ †‡ †‡ -2 0 1 2 3 Years P<0.05 * ETN vs MTX, † combo vs MTX ‡ combo vs ETN van der Heijde, et al. Ann Rheum Dis 2006;65(Suppl. II):509

  5. TEMPO extension study: DAS28 remission ETN + MTX Combination (n=96) 15% MTX add ETN (n=55) ETN add MTX (n=76) 64% (p<0.05) 47% 56% (p<0.05) 42% 41% 40% 25% 26% Martin Mola E et al. Presented at EULAR 2007. FRI0148.

  6. BeSt Treatment Strategies

  7. 100 80 60 % with DAS44 <1.6 40 20 0 0 3 6 9 12 15 18 21 24 Time (months) sequential mono step-up combination combi with prednisone combi with infliximab Percentage in remission in BeSt De Vries – Bouwstra Ann Intern Med 2007; 146: 406-15.

  8. Results: Summary • At 5 years • 48% of patients in DAS remission • 10% - 19% of patients in drug-free remission • 51 patients previously in drug-free remission had restarted a DMARD Klarenbeek et al. Ann Rheum Dis 2008;67(Suppl II):187

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