The European Alliance of Associations for Rheumatology (EULAR), together with the American College of Rheumatology (ACR), updated their criteria for defining remission in rheumatoid arthritis (RA) in 2022. These criteria help doctors determine when a patient’s RA is under control, meaning the disease is not causing significant symptoms or damage. Below is a simple summary of the key points:
What is Remission in RA?
Remission means the disease is very well controlled, with minimal or no signs of inflammation or joint damage, allowing patients to live with fewer symptoms and better quality of life.
Key Updates to the 2022 Remission Criteria
The 2022 revision builds on the 2011 criteria and includes two main ways to define remission: Boolean-based and index-based. The main change is a slight adjustment to make the criteria more practical while ensuring they remain accurate.
1. Boolean-Based Criteria (Boolean2.0):
- A patient is in remission if all of the following are true:
- Tender joint count (TJC): No more than 1 tender joint (out of 28 joints checked).
- Swollen joint count (SJC): No more than 1 swollen joint (out of 28 joints checked).
- C-reactive protein (CRP): A level of 1 mg/dL or less (a blood test showing low inflammation).
- Patient global assessment (PtGA): A score of 2 or less (on a 0–10 scale, where patients rate how active they feel their RA is).
- The key change from 2011 is raising the PtGA threshold from 1 to 2, making it easier for patients to meet the remission criteria while still ensuring the disease is well-controlled.
2. Index-Based Criteria:
- Uses scores from tools like the Simplified Disease Activity Index (SDAI) or Clinical Disease Activity Index (CDAI):
- SDAI ≤ 3.3: Combines tender and swollen joint counts, patient and doctor assessments, and CRP levels.
- CDAI ≤ 2.8: Similar to SDAI but without the CRP blood test.
- These tools give a numerical score to measure disease activity, and low scores indicate remission.
Why the Update?
- The higher PtGA threshold (2 instead of 1) was tested in clinical trials and found to better align the Boolean and index-based criteria, making them more consistent.
- The updated criteria were validated to predict good outcomes, like better physical function (e.g., ability to move and perform daily tasks) and less joint damage seen on X-rays.
How It Helps
- These criteria guide doctors to assess whether treatments (like medications) are working effectively.
- They support a “treat-to-target” approach, where the goal is to reach remission or low disease activity through regular monitoring and adjusting treatments.
- Patients benefit from clearer goals for managing RA, which can improve their quality of life.
Source
This summary is based on the 2022 ACR/EULAR remission criteria for rheumatoid arthritis, published in Annals of the Rheumatic Diseases (2023). It is available here also in pdf.
We would love to here if your rheumatoid arthritis has gone into remission.
