The achievement of true full clinical remission of rheumatoid arthritis (RA) is the goal of both patients and rheumatologists. There still is much discrepancy, with resulting confusion, in how remission is defined despite the consensus reached by the American College of Rheumatology and the European League Against Rheumatism that the most reliable definition of true remission is either a Boolean definition or a Simplified Disease Activity Index (SDAI) score < 3.31. Other proposed remission cutoffs, including those for Disease Activity Score (DAS), 28-joint DAS (DAS28), and Routine Assessment of Patient Index Data 3 (RAPID-3), are much less stringent, and thus allow far more patients to be considered as having achieved “remission” despite the possibility of continued active disease in the joints with systemic inflammation (Figure 1)2. The accurate measurement of disease activity with a fully validated instrument is a key component of RA management.
Over the past decade there has been much interest in the discovery of biomarkers that can identify the complex and heterogeneous biology of RA and have the ability to reliably demonstrate the absolute degree of disease activity, both peripherally and systemically, in all patients. One instrument, which has claimed to be …
Address correspondence to Dr. R. Fleischmann, 8144 Walnut Hill Lane, Suite 810, Dallas, Texas 75231, USA. E-mail: rfleischmann{at}arthdocs.com