TY - JOUR T1 - Patient-reported Remission in Rheumatoid Arthritis JF - The Journal of Rheumatology JO - J Rheumatol SP - 350 LP - 352 DO - 10.3899/jrheum.130098 VL - 40 IS - 4 AU - Lilian H.D. van Tuyl AU - Maarten Boers Y1 - 2013/04/01 UR - http://www.jrheum.org/content/40/4/350.abstract N2 - In 2010, remission was redefined1. The set of 4 proposed criteria — 2 clinical trial criteria and 2 clinical practice criteria — have since been the subject of several validation studies. Rheumatology researchers have shown that clinical trial criteria requiring a tender joint count, swollen joint count, C-reactive protein (CRP) and patient global assessment ≤ 1 or a Simplified Disease Activity Index (SDAI) ≤ 3.3 perform well in both trial and clinical-practice settings2,3,4,5,6.Fewer data are available on the performance of the practice-based criteria, which exclude the CRP criterion to increase feasibility. Shahouri, et al reported good agreement between the trial and practice-based criteria, and both Lillegraven and Zhang reported comparable predictive validity of the practice-based criteria in observational datasets as compared to trial datasets from which they were developed2,3,6.Reported prevalence rates of remission according to the new criteria range between 5% and 25%2,3,4,5,6,7,8,9, a marked decline compared to reported DAS-based remission rates between 25% and 50%, and even one instance of 90%10. We now refer to Disease Activity Score (DAS)-based remission as minimal disease activity.Despite these developments, there are some concerns with the new criteria, especially regarding the requirement of patient global assessment (PtGA) ≤ 1. Both Masri, et al and Studenic, et al independently report that the PtGA requirement decreases the specificity of the criteria, especially with the report of noninflammatory problems like low back pain, contributing to false-negative cases11 … ER -