Although remission is the desired outcome for rheumatoid arthritis (RA), there is not enough evidence to support changing remission criteria to incorporate patient perspectives, according to findings from the Outcome Measures in Rheumatology (OMERACT) 2020, published in Seminars in Arthritis and Rheumatism.

At OMERACT 2010, there were concerns regarding the adequate consideration of patient perspectives, such as tender and swollen joint count, C-reactive protein (CRP), and patient global assessment of disease activity, in the American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) remission criteria.

Authors of the current report aimed to assess the best way to incorporate patient perspectives into RA remission criteria, based on data presented at OMERACT 2020.


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A literature review was conducted in which studies were identified that aimed to include patient perspectives into an existing core outcome set for a long-term physical health condition and that analyzed patient perspectives of the definition of remission in RA.

In a meta-analysis of patient global assessment of disease activity and remission, 11 randomized controlled trials that included individual patient data were reviewed. Outcomes suggested that the current remission definition that includes patient global assessment, as well as tender and swollen joint counts and CRP, performs better in predicting good functional outcome than a remission definition that does not include patient global assessment. Conversely, the addition of patient global assessment to the remaining remission criteria resulted in a reduction of predictive accuracy for good radiographic outcomes with a potential risk for overtreatment.

A virtual special interest group (SIG) of 46 participants presented and discussed the findings at OMERACT 2020 and voted in a poll, which included a series of questions.

In a longitudinal study that assessed the validity of adding patient-valued domains to the ACR/EULAR criteria, the SIG noted that the measure of independence could not be validated, as it could be subjective and influenced by contextual factors.

For the influence of patient global assessment on RA remission, the group had 2 main suggestions, which were to increase the patient group assessment cutoff from 1 to 2 of the 10 remission criteria and to create a patient’s perspective of remission criteria that would be separate from the physician’s perspective.

The consensus among SIG members was that there was currently not enough evidence to alter the remission criteria. The OMERACT Remission in RA: Patient Perspective Working Group identified domains that were important to patients in regard to remission and planned to create and test a measure of independent for RA through qualitative work to further characterize and define the domain of independence.

“In conclusion, there is insufficient evidence from the current data to propose a change to the existing ACR/EULAR remission criteria,” the authors of the report wrote. “However, independence is an important domain in need of further research to clarify the meaning with patients and to identify the best way to measure this. Work should also continue on the patient global assessment in relation to remission,” they concluded.

Disclosure: Multiple authors declared affiliations with the industry. Please refer to the original article for a full list of disclosures.

Reference

Jones B, Flurey CA, Proudman S, et al. Considerations and priorities for incorporating the patient perspective on remission in rheumatoid arthritis: an OMERACT 2020 special interest group report. Semin Arthritis Rheum. Published online July 11, 2021. doi:10.1016/j.semarthrit.2021.07.010