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The prevalence of clinical remission in RA patients treated with anti-TNF: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry.
Rheumatology (Oxford). 2012 Sep; 51(9):1610-7.R

Abstract

OBJECTIVES

To evaluate the prevalence of clinical remission and minimal disease activity according to the ACR/European League Against Rheumatism (EULAR) remission, DAS-28 <2.6 and minimal disease activity (MDA) criteria, and to compare the extent of residual disease activity with disability in RA patients after 6 months of treatment with anti-TNF.

METHODS

In the Dutch Rheumatoid Arthritis Monitoring (DREAM) biologic registry the prevalence of DAS-28 <2.6, MDA and ACR/EULAR remission criteria was assessed. Residual disease activity during MDA or remission was assessed as the percentage of patients with swollen and tender joints, elevated acute-phase reactants and general health on a visual analogue scale (VAS). Disability was evaluated with the HAQ score.

RESULTS

Prevalence of DAS-28 <2.6 was 27%, prevalence of MDA was 34% and ACR/EULAR remission was reached by 6% of patients. Residual disease activity was present mostly in the most lenient criteria and occurred most frequently on the level of swollen joint count and VAS score: at least one swollen joint in DAS-28 <2.6, MDA and ACR/EULAR remission was present in, respectively, 51, 54 and 34% of the patients. VAS >1 occurred in, respectively, 67, 69 and 0% of the patients. Modification of the cut-point of the patient-reported outcome increased the prevalence of ACR/EULAR remission, but also the level of disability.

CONCLUSION

MDA and DAS-28 <2.6 are reachable treatment targets in RA with anti-TNF, although residual disease activity might still be present. In turn, ACR/EULAR remission criteria leave little residual disease activity, but might be too stringent for use in daily clinical practice due to the strict cut-point in the patient-reported outcome.

Authors+Show Affiliations

Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Y.dePunder@reuma.umcn.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22539487

Citation

de Punder, Yvonne M R., et al. "The Prevalence of Clinical Remission in RA Patients Treated With anti-TNF: Results From the Dutch Rheumatoid Arthritis Monitoring (DREAM) Registry." Rheumatology (Oxford, England), vol. 51, no. 9, 2012, pp. 1610-7.
de Punder YM, Fransen J, Kievit W, et al. The prevalence of clinical remission in RA patients treated with anti-TNF: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Rheumatology (Oxford). 2012;51(9):1610-7.
de Punder, Y. M., Fransen, J., Kievit, W., Houtman, P. M., Visser, H., van de Laar, M. A., & van Riel, P. L. (2012). The prevalence of clinical remission in RA patients treated with anti-TNF: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Rheumatology (Oxford, England), 51(9), 1610-7. https://doi.org/10.1093/rheumatology/kes078
de Punder YM, et al. The Prevalence of Clinical Remission in RA Patients Treated With anti-TNF: Results From the Dutch Rheumatoid Arthritis Monitoring (DREAM) Registry. Rheumatology (Oxford). 2012;51(9):1610-7. PubMed PMID: 22539487.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The prevalence of clinical remission in RA patients treated with anti-TNF: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. AU - de Punder,Yvonne M R, AU - Fransen,Jaap, AU - Kievit,Wietske, AU - Houtman,Pieternella M, AU - Visser,Henk, AU - van de Laar,Mart A F J, AU - van Riel,Piet L C M, Y1 - 2012/04/26/ PY - 2012/4/28/entrez PY - 2012/4/28/pubmed PY - 2012/10/26/medline SP - 1610 EP - 7 JF - Rheumatology (Oxford, England) JO - Rheumatology (Oxford) VL - 51 IS - 9 N2 - OBJECTIVES: To evaluate the prevalence of clinical remission and minimal disease activity according to the ACR/European League Against Rheumatism (EULAR) remission, DAS-28 <2.6 and minimal disease activity (MDA) criteria, and to compare the extent of residual disease activity with disability in RA patients after 6 months of treatment with anti-TNF. METHODS: In the Dutch Rheumatoid Arthritis Monitoring (DREAM) biologic registry the prevalence of DAS-28 <2.6, MDA and ACR/EULAR remission criteria was assessed. Residual disease activity during MDA or remission was assessed as the percentage of patients with swollen and tender joints, elevated acute-phase reactants and general health on a visual analogue scale (VAS). Disability was evaluated with the HAQ score. RESULTS: Prevalence of DAS-28 <2.6 was 27%, prevalence of MDA was 34% and ACR/EULAR remission was reached by 6% of patients. Residual disease activity was present mostly in the most lenient criteria and occurred most frequently on the level of swollen joint count and VAS score: at least one swollen joint in DAS-28 <2.6, MDA and ACR/EULAR remission was present in, respectively, 51, 54 and 34% of the patients. VAS >1 occurred in, respectively, 67, 69 and 0% of the patients. Modification of the cut-point of the patient-reported outcome increased the prevalence of ACR/EULAR remission, but also the level of disability. CONCLUSION: MDA and DAS-28 <2.6 are reachable treatment targets in RA with anti-TNF, although residual disease activity might still be present. In turn, ACR/EULAR remission criteria leave little residual disease activity, but might be too stringent for use in daily clinical practice due to the strict cut-point in the patient-reported outcome. SN - 1462-0332 UR - https://www.unboundmedicine.com/medline/citation/22539487/The_prevalence_of_clinical_remission_in_RA_patients_treated_with_anti_TNF:_results_from_the_Dutch_Rheumatoid_Arthritis_Monitoring__DREAM__registry_ L2 - https://academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/kes078 DB - PRIME DP - Unbound Medicine ER -