Methods used to assess remission and low disease activity in rheumatoid arthritis Francesca Ometto, Costantino Botsios, Bernd Raffeiner, Paolo Sfriso ⁎, Livio Bernardi, Silvano Todesco, Andrea Doria, Leonardo Punzi Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Italy abstract article info Article history: Received 1 July 2009 Accepted 7 July 2009 Available online 19 July 2009 Keywords: Rheumatoid arthritis Remission Low disease activity Disease activity Radiographic remission The aim of the treatment in rheumatoid arthritis (RA) is to prevent articular damage and functional loss by decreasing the activity of the disease. The overall goal is the full suppression of the activity of the disease, also called clinical remission. The most reliable indices to assess RA activity were defined by the American College of Rheumatology (ACR), the European League Against Rheumatism (EULAR) and the International League Against Rheumatism (ILAR) and are habitually used for the evaluation of remission. The Food and Drug Administration (FDA) established three increasingly restrictive categories of disease remission: complete clinical response, major clinical response, and remission. Then, OMERACT (Outcome Measures in Rheumatoid Arthritis Clinical Trials) advanced the concept of low disease activity state (LDAS) or minimal disease activity (MDA). Thus, those reported by FDA are the only criteria for remission which consider radiographic arrest of the disease. This review aims to describe the criteria for RA remission and to discuss their advantages and limitations. © 2009 Elsevier B.V. All rights reserved. Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 2. Efforts to define remission and reliability of present criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 2.1. ACR criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 2.2. EULAR criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 2.3. Simplified disease activity index (SDAI) and clinical disease activity index (CDAI) . . . . . . . . . . . . . . . . . . . . . . . . . . 162 2.4. FDA criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 2.5. Radiographic remission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 3. Low disease activity state (LDAS) or minimal disease activity (MDA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 4. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Take-home messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Introduction The progressive clarification in the pathogenesis of Rheumatoid arthritis (RA) and the subsequent biopharmaceutical discoveries, led to the establishment of more effective medications [1–3]. Indeed, successful long term use of biological agents require ongoing monitoring to avoid drug toxicity [4–7]. However, since biologic response modifiers have been proved to markedly reduce signs and symptoms of the disease, better outcomes are expected, and reported. Thus, remission has become the goal of RA therapy [8]. Key point to an optimal treatment success in RA is an aggressive treatment approach to the disease [9]. Patients should be assessed at least once every 3months, and activity should be evaluated using the proposed indices [10]. Standardized measures allow an evaluation of the disease over time with the possibility of designing a progress chart, therefore highlighting effects of treatment. The impressive achievements in controlling RA have needed parallel development of the methods suitable to assess the results of the new medications. Adequate instruments to define remission in RA have been proposed on the basis of patients' follow-up both in trials and in clinical practice and then validated [11,12]. To date recommen- dations are the result of collaborative efforts between the European Autoimmunity Reviews 9 (2010) 161–164 ⁎ Corresponding author. Rheumatology Unit, Department of Clinical and Experi- mental Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy. Tel.: +39 0498212190; fax: +39 0498212191. E-mail address: paolo.sfriso@unipd.it (P. Sfriso). 163 1568-9972/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.autrev.2009.07.001 Contents lists available at ScienceDirect Autoimmunity Reviews journal homepage: www.elsevier.com/locate/autrev