Abstract: Frequency of Remissions in Early Rheumatoid Arthritis Defined by 3 Sets of Criteria. A 5-Year Followup Study

Frequency of Remissions in Early Rheumatoid Arthritis Defined by 3 Sets of Criteria. A 5-Year Followup Study

HEIDI MÄKINEN, HANNU KAUTIAINEN, PEKKA HANNONEN, and TUULIKKI SOKKA

ABSTRACT.

Objective. To study the frequency of remission using 3 sets of criteria in patients with rheumatoid arthritis (RA) at 5 years after the diagnosis.

Methods. All adult patients with recent onset inflammatory arthritis who did not meet criteria or show clinical signs of other specific arthritides were included in the RA1997 inception cohort at Jyväskylä Central Hospital, Finland, and were assessed for remission at 5-year control examination. Remission was defined as (1) American College of Rheumatology (ACR) remission (fatigue excluded), (2) clinical remission with no tender and no swollen joints and normal erythrocyte sedimentation rate, and (3) radiographic remission with no worsening of erosions and no new erosions from baseline to 5 years.

Results. The study included 127 patients with early RA (mean age 56 yrs, 61% female, 54% with positive rheumatoid factor, and 25% with erosions). At 5 years, 111 patients were examined, 17% (95% CI 11%–25%) of whom met ACR remission criteria, 37% (95% CI 28%–47%) met clinical remission criteria, and 55% (95% CI 49%–68%) met radiographic remission criteria. Only 13 (12%) patients met all 3 sets of remission criteria. The rate of remission was statistically significantly different (p < 0.001) using the 3 sets.

Conclusion. The rate of remission in RA depends on the criteria used. No gold standard exists for defining remission in RA. A set of criteria including no sign of inflammatory activity and no radiographic progression might be a basis for development of clinically relevant remission criteria for RA. (J Rheumatol 2005;32:796-800)

Key Indexing Terms:

REMISSION
RHEUMATOID ARTHRITIS
EARLY RHEUMATOID ARTHRITIS

From the Jyväskylä Central Hospital, Jyväskylä, Finland.

H. Mäkinen, MD, Jyväskylä Central Hospital; H. Kautiainen, BA, Rheumatism Foundation Hospital, Heinola, Finland; P. Hannonen, MD, PhD, Jyväskylä Central Hospital; T. Sokka, MD, PhD, Jyväskylä Central Hospital and Vanderbilt University Medical School, Nashville, Tennessee, USA.

Address reprint requests to Dr. H. Mäkinen, Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland. E-mail: heidi.makinen@ksshp.fi

Accepted December 20, 2004.