The first provisional criteria for defining remission in RA were established by EULAR and the ACR in 2011. Two types of remission definitions were agreed upon. The first, called the Boolean definition, required a person to have a score of 1 or less in each of four core variables: tender joint count, swollen joint count, patient global assessment (PtGA), and C-reactive protein (CRP) – a measure of inflammation. The index-based definition used the remission cut-off point of the Simplified Disease Activity Index (SDAI).

Critics have argued that the threshold of 1 or lower for the PtGA is too strict. Some patients may not meet this threshold even if they meet the other criteria. This is significant because PtGA is an important measure of disease activity and one of the most sensitive measures used in clinical trials. Recent data suggests that setting a higher threshold for the PtGA could improve agreement between the two sets of remission criteria.

The researchers collected patient data from four clinical trials that tested the effectiveness of different biological disease-modifying antirheumatic drugs (bDMARDs) compared to a placebo or methotrexate. The authors raised the threshold of the PtGA in 0.5 cm increments, from 1.0 up to 2.5. Additionally, they examined a Boolean definition that did not include the PtGA criterion at all.

t:As expected, using a patient global assessment (PtGA) of 2 cm resulted in higher remission rates compared to using 1 cm. Omitting PtGA altogether further increased the remission rates. It is important to note that there were no differences in radiographic progression observed in people with established rheumatoid arthritis (RA) who achieved remission according to the different definitions.It is important to note that while these revised definitions allow more people to be classified as in remission, the European League Against Rheumatism (EULAR) emphasizes that the definition of remission should remain strict. This is to ensure beneficial long-term outcomes and to prevent unnecessary treatment escalation.

remission criteria, to include a threshold of 2 cm rather than 1 cm for the PtGA criterion. It is proposed that this change be adopted both for future clinical trials and as a target in clinical

practice.