TY - JOUR T1 - Through the Looking Glass: “Remission” in Rheumatoid Arthritis JF - The Journal of Rheumatology JO - J Rheumatol SP - 1371 LP - 1373 DO - 10.3899/jrheum.100495 VL - 37 IS - 7 AU - VEENA K. RANGANATH Y1 - 2010/07/01 UR - http://www.jrheum.org/content/37/7/1371.abstract N2 - “When I use a word, it means just what I choose it to mean” — Lewis Carroll: Through the Looking GlassThe original definition of rheumatoid arthritis (RA) remission dates from the 1950s when Short and Bauer described a state where “the disease was inactive, the patients were asymptomatic, and examination of the joints was negative except for residual deformity”1,2. About 3 decades later, this overall concept of remission in RA remained remarkably similar when Pinals and colleagues defined “complete” RA remission as the “total absence of all articular and extra-articular inflammation and immunological activities related to RA”3. Only a few patients with RA were fortunate enough to meet these elusive definitions, but the increasing effectiveness of disease modifying antirheumatic drugs (DMARD) and biologic agents, which were previously unavailable, now offers tangible expectations for improvement. Now, almost 6 decades later, “remission” is touted as the goal for RA treatment.In this issue of The Journal, Ma and colleagues describe a systematic review of the literature of remission in early RA, and showcase the necessity for standardization of RA remission definitions so that direct comparisons across studies can be made4. The overall purpose of their extensive examination of the literature from 1996 to 2008 was to evaluate: (1) frequency of remission as defined by the American College of Rheumatology (ACR) Remission Criteria and Disease Activity Score (DAS), as well as their current modifications; (2) frequency of remission in patients given monotherapy versus those given combination therapy; and (3) effects of remission on progression of radiographic damage, in both randomized clinical trials (RCT) and prospective observational studies. Twenty RCT and 17 observational early RA studies were ultimately included in the final analyses. About 27% of 4762 RA patients with disease duration < 3 years achieved remission criteria by either ACR … Address correspondence to Dr. V. Ranganath, Rehabilitation Building, Room 32-98, UCLA, 1000 Veteran Avenue, Los Angeles, CA 90024. E-mail: vranganath{at}mednet.ucla.edu ER -