RT Journal Article SR Electronic T1 Validity and Reliability Problems with Patient Global as a Component of the ACR/EULAR Remission Criteria as Used in Clinical Practice JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP jrheum.111543 DO 10.3899/jrheum.111543 A1 Karim R. Masri A1 Timothy S. Shaver A1 Shadi H. Shahouri A1 Shirley Wang A1 James D. Anderson A1 Ruth E. Busch A1 Kaleb Michaud A1 Ted R. Mikuls A1 Liron Caplan A1 Frederick Wolfe YR 2012 UL http://www.jrheum.org/content/early/2012/05/14/jrheum.111543.abstract AB Objective To investigate what factors influence patient global health assessment (PtGlobal), and how those factors and the reliability of PtGlobal affect the rate, reliability, and validity of recently published American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria when used in clinical practice. Methods We examined consecutive patients with RA in clinical practice and identified 77 who met ACR/EULAR joint criteria for remission (≤ 1 swollen joint and ≤ 1 tender joint). We evaluated factors associated with a PtGlobal > 1, because a PtGlobal ≤ 1 defined ACR/EULAR remission in this group of patients who had already met ACR/EULAR joint criteria. Results Of the 77 patients examined, only 17 (22.1%) had PtGlobal ≤ 1 and thus fully satisfied ACR/EULAR criteria. A large proportion of patients not in remission by ACR/EULAR criteria had high PtGlobal related to noninflammatory issues, including low back pain, fatigue, and functional limitations, and a number of patients clustered in the range of PtGlobal > 1 and ≤ 2. However, the minimal detectable difference for PtGlobal was 2.3. In addition, compared with a PtGlobal severity score, a PtGlobal activity score was 3.3% less likely to be abnormal (> 1). Conclusion Noninflammatory factors contribute to the level of PtGlobal and result in the exclusion of many patients who would otherwise be in “true” remission according to the ACR/EULAR definition. Reliability problems associated with PtGlobal can also result in misclassification, and may explain the observation of low longterm remission rates in RA. As currently constituted, the use of the ACR/EULAR remission criteria in clinical practice appears to be problematic.