J Korean Med Sci.  2016 Dec;31(12):1907-1913. 10.3346/jkms.2016.31.12.1907.

Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis

• Sung YK
• Cho SK
• Kim D
• Yoon BY
• Choi CB
• Cha HS
• Choe JY
• Chung WT
• Hong SJ
• Jun JB
• Kang YM
• Kim J
• Kim TH
• Kim TJ
• Koh E
• Lee CK
• Lee J
• Lee SS
• Lee SW
• Lee HS
• Lee YA
• Park SH
• Yoo DH
• Yoo WH
• Bae SC
• the KORONA Investigators

• KMID: 2355618
• DOI: http://doi.org/10.3346/jkms.2016.31.12.1907

Abstract

Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician's clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.

Keyword

Arthritis, Rheumatoid; Remission; Discordance

MeSH Terms

Arthritis
Arthritis, Rheumatoid*
Classification
Consensus
Fatigue
Humans
Judgment*
Logistic Models
Observational Study
Rheumatic Diseases

Figure

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  Fig. 1 Prevalence of remission in patients with RA according to each set of criteria. DAS = disease activity score, CRP = C-reactive protein, ESR = erythrocyte sedimentation rate, SDAI = simplified disease activity index, CDAI = clinical disease activity index.

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