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Reexamining remission definitions in rheumatoid arthritis: considering the twenty-eight–joint Disease Activity Score, C-reactive protein level and patient global assessment
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  • Published on:
    Correspondence on “Re-examining remission definitions in rheumatoid arthritis: considering the 28-Joint Disease Activity Score, C-reactive protein level and patient global assessment” by Felson et al.
    • Ricardo J. O. Ferreira, Specialist Nurse Rheumatoly department, Centro Hospitalar e Universitário de Coimbra
    • Other Contributors:
      • Paco M. J. Welsing, Statistician
      • Johannes W. G. Jacobs, Rheumatologist
      • Laure Gossec, Rheumatologist
      • Mwidimi Ndosi, Specialist Nurse
      • Pedro M. Machado, Rheumatologist
      • Désirée van der Heijde, Rheumatologist
      • José A. P. da Silva, Rheumatologist

    Dear Editor:
    We read with great interest the editorial by Felson et al. on definitions of remission in rheumatoid arthritis (RA).[1] It gives a comprehensive and historical overview of the development of remission criteria, and provides a well-founded critique of remission criteria based on the 28-joint Disease Activity Score (DAS28). DAS28 has been primarily developed and validated for evaluations at the group level, i.e. for measuring effects in clinical trials. However, in almost forgotten earlier times, when patient remission was rarely achieved, there was a need for a single index, expressing disease activity of the individual patient, and the only instrument available was the 44-joint Disease Activity Score (DAS).[2] When biologicals become available, in many countries of Europe, use of DAS28 as single index of disease activity was also stimulated by health authorities and insurance companies, requiring DAS28 proof of active RA and documented previous treatment failure (or contra-indication) of conventional synthetic DMARDs, before allowing reimbursement of an (expensive) biological drug. Since then, remission has proved to be an achievable goal, and for clinical trials and for individual patients, DAS28 cut-offs have been used for this purpose, especially in Europe, although their limitations for evaluations at the individual patient level have indeed been recognised.[3]
    Moreover, we agree with Felson et al. that patient global assessment (PGA) is a valu...

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    Conflict of Interest:
    None declared.