Reaching RA remission is a realistic goal

Remission is a realistic goal for patients with rheumatoid arthritis (RA), especially with intensive combination treatment regimens provided early in the disease course. The Disease Activity Score 28 (DAS28) remission criteria appear to be easiest to achieve.

Ma and coworkers retrospectively reviewed data from observational studies and randomized controlled trials. They tried to determine which treatments produce the highest rates of remission according to various criteria and how remission correlates with radiological status.

Patients who received combination therapy with several disease-modifying antirheumatic drugs (DMARDs), with or without tumor necrosis factor inhibitors, had the highest remission rates. According to American College of Rheumatology and DAS criteria, remission rates averaged 24% and 42%, respectively, for combination DMARD treatment versus 16% and 26% for DMARD monotherapy. The incidence of remission in observational studies averaged 15% and 22% in persons receiving 1 or several DMARDs, respectively. During clinical trails, the incidences of remission were slightly higher at 16% and 24%. Collective data showed that radiographic changes occur even during remission but are slowed by combination DMARD therapy.

The authors noted that there is an urgent need for international consensus on assessing and reporting true remission states.