Remission in Rheumatoid Arthritis: Physician and Patient Perspectives

Objective. To examine the prevalence of remission in rheumatoid arthritis (RA) as determined by physicians and patients independently, and to determine the degree of agreement among methods, the strength of predictor variables of remission, and the length of remission. Methods. Eight hundred patients with RA completed a remission questionnaire on the day of their rheumatologist visit and their rheumatologists completed a separate questionnaire the same day. The question(s) were: "Given all your experience with disease activity in RA, are you [is your patient] currently in remission?". Patients also completed 0-10 visual analog scales for RA activity, pain, and functional limitation. Results. The percentage of patients in remission by physician and patient assessment was 34.8% [95% confidence interval (CI) 31.4-38.2] and 30.9% (95% CI 27.7-34.20), respectively. The percentage of patients classified concordantly (full agreement) was 78.6%, and the associated kappa statistic was 0.54 (95% CI 0.45-0.58). The median duration of remission was 2.0 years. The median RA activity, pain, and functional scores were 1.0, 1.5, and 1.25 for patient-determined remission and 1.5, 1.5, and 1.5 for physician-determined remission. Conclusion. Physician and patient estimates of remission in RA are similar (34.8% to 30.9%), and agreement was 78.6% (kappa 0.53). Based on previous data and the observed presence of disease activity, this definition of remission appears to be a measure of minimal disease activity rather than true remission. The problem of remission rates will not be solved until a consensus definition that has relevance in research and the clinic is developed. (First Release April 1 2009; J Rheumatol 2009;36:930-3; doi: 10.3899/jrheum.080947)