Abstract
Validity and risk of setting patient’s global assessment (PGA) ≤ 2 as a Boolean remission criteria substituting PGA ≤ 1 in treating rheumatoid arthritis (RA) was investigated. Patients were recruited from an area cohort, of whom attained Boolean remission (Boolean-1) or near remission with PGA ≤ 2 and the rest components were ≤ 1 (Boolean-2). Simplified disease activity index (SDAI) score was compared according to the criteria variations. A total of 517 patients were studied. Mean SDAI score of patients with Boolean-1 was significantly lower than that of patients with Boolean-2 at acquisition. The trend was evident in the patients who attained Boolean-1 remission. Mean SDAI score at acquisition, 6 months after, and 1 year after of patients who attained Boolean-2 first and then Boolean-1, was significantly inferior to that of patients who attained the remissions at the same time. The mean SDAI score at month 6 in the Boolean-2 was not SDAI remission at all. We concluded that setting PGA ≤ 2 as a remission criteria may not have statistical difference in disease activity from PGA ≤ 1, however, there was an determinant risk to misread that includes patient who losses clinical remission after acquisition.
Highlights
Abbreviations T2T Treat-to-target rheumatoid arthritis (RA) Rheumatoid arthritis ACR American College of Rheumatology EULAR European League against Rheumatism tenderness joint count (TJC) Tenderness joint count swollen joint count (SJC) Swollen joint count patient’s global assessment (PGA) Patient’s global assessment CRP C-reactive protein activities of daily living (ADL) Activities of daily living Boolean-1, Boolean remission with PGA ≤ 1, TJC ≤ 1, SJC ≤ 1, and CRP ≤ 1 Boolean-2 Boolean remission with PGA ≤ 2, TJC ≤ 1, SJC ≤ 1, and CRP ≤ 1 Group-1 A patient group who attained Boolean-1 remission Group-2 A patient group who attained Boolean-2 Group-same1&2 A patient group in the Group-1 who attained Boolean-1 and Boolean-2 remissions at the same time Group-step[1] to 2 A patient group in the Group-1 who attained Boolean-2 remission first and attained
ACR/EULAR Boolean remission is the most stringent measure of disease activity[3], and it is known that patients who achieve Boolean remission, which is defined as to attain one or less in all of tenderness joint count (TJC), swollen joint count (SJC), patient’s comprehensive evaluation (PGA), and C-reactive protein (CRP)[4,5], can maintain stable disease activity control and activities of daily living for a long period after achieving remission[6]
It is difficult to achieve a PGA score of ≤ 1, and it has been argued that even mildly lax criteria can be regarded as a clinical remission, which may lead to assurance of maintenance of activities of daily living (ADL)[8,9]
Summary
Abbreviations T2T Treat-to-target RA Rheumatoid arthritis ACR American College of Rheumatology EULAR European League against Rheumatism TJC Tenderness joint count SJC Swollen joint count PGA Patient’s global assessment CRP C-reactive protein ADL Activities of daily living Boolean-1, Boolean remission with PGA ≤ 1, TJC ≤ 1, SJC ≤ 1, and CRP ≤ 1 Boolean-2 Boolean remission with PGA ≤ 2, TJC ≤ 1, SJC ≤ 1, and CRP ≤ 1 Group-1 A patient group who attained Boolean-1 remission Group-2 A patient group who attained Boolean-2 Group-same1&2 A patient group in the Group-1 who attained Boolean-1 and Boolean-2 remissions at the same time Group-step[1] to 2 A patient group in the Group-1 who attained Boolean-2 remission first and attained. When pain is taken into account as a clinical decision index, Boolean remission is considered to be a rational index configuration
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