文档介绍：Defining Remission
in Rheumatoid Arthritis
Part 1:
Why is a new remission definition in rheumatoid arthritis needed?
Background
Increasing numbers of patients reach remission
Abundance of remission definitions
‘strict’ definitions: American Rheumatism Association (Pinals); SDAI/CDAI
‘loose’ definitions: DAS/DAS28; mARA; SJC0/TJC0/ESR10; MDA
Need for a uniform definition
(RA trials, practice)
Etymology
Remittere (L): to send back; to decrease; to relax...
Remission
(med dictionary): an abatement or lessening of the manifestations of a disease
(Wiki): the state of absence of disease activity in patients with a chronic illness, with the possibility of return of disease activity
Concept: Key Points
Remission is a state, not change or transition
Absence of disease activity
Concept: Remission
Related but not identical to remission:
Cure: disease does not return
Arrest: disease progression is stopped
Intermission: period of no activity between two periods of active disease
Remission is antithetical to the following:
Relapse: return of disease activity
Flare: substantial increase of disease activity
Current Definitions: American Rheumatism Association*
5 or more must be fulfilled for at least 2 consecutive months:
Morning stiffness not exceeding 15 minutes
No fatigue
No joint pain (by history)
No joint tenderness or pain on motion
No soft tissue swelling in joints or tendon sheaths
ESR (W) < 30 mm/h (f); < 20 mm/h (m)
* Pinals RS, et al. Arthritis Rheum 1981;24:1308-15.
ARA (Pinals)
3 groups of RA patients classified according to the rheumatologist:
complete remission
partial remission
active disease
Sensitivity 72%; Specificity 90% (against partial remission)
Problems with ARA (Pinals) Definition
Depends on measures not widely assessed now in RA trials:
Morning stiffness (absent in many patients with active RA)
Tendon sheath swelling
Very strict definition
Attainment very rare in RA trials
Thus unrealistic target for treatment ess