Background/Purpose:  The goal in treatment of rheumatoid arthritis (RA) is to achieve a state of clinical remission. Updated treatment recommendations by EULAR/ACR task force highlight the importance of using validated composite measures of disease activity in routine clinical practice and emphasize the need for objective and measure-based treatment decision making. The DAS28 (ESR) is a standard tool used to assess RA disease activity endorsed by ACR and EULAR. This study examined the concordance of physician-stated remission and DAS28 remission.

Methods:  Data were drawn from the 2014 Adelphi RA Disease Specific Programme in 5 European countries (France, Germany, Italy, Spain, UK). Rheumatologists provided details about the RA patients who visited them, including the use of composite clinical measures. Physician-stated remission was based on the question, “Is this patient currently in remission?” DAS28(3)-ESR remission was defined as a score <2.6. Multivariate logistic regression analyses were performed to investigate factors associated with discrepancies in rheumatologist-reported and DAS28 remission. Variables included in the multivariate model were selected based on clinical relevance and univariate analyses.

Results:  This analysis included 307 physicians and 2,536 patients. Overall, 87.6% of rheumatologists practiced in a hospital (vs office only). For the 2,536 patients in this analysis, an objective measure of disease activity was performed for 1,386 (55.0%) of patients at the reference consultation, with notable regional variation. Out of 1,386 patients, 369 (26.6) had rheumatologist-reported remission and DAS28(3)-ESR defined remission; 575 (41.5%) had no remission from neither of the measurement; 41 (3.0%) patients’ rheumatologist did not report remission but DAS28(3)-ESR remission was achieved; while 401 (28.9%) had rheumatologist-reported remission but not DAS28(3)-ESR defined remission. Multivariate analyses indicated that physician-reported anxiety and/or depression (odds ratio [OR] = 2.94), medium/high current pain assessment (OR = 3.10), and structural damage (OR = 2.00) were all significantly associated with physician over-reporting of remission compared with both physician and DAS28(3)-ESR agreement of remission (all P≤0.001). Agreement on a treat-to-target measure was significantly associated with lower likelihood of physician over-reporting of remission (OR = 0.46; P = 0.001).

Conclusion:  Objective measures of RA disease activity are not universally used in clinical practice when reporting remission; when they are used, discordance exists between physician-reported remission and observed DAS28 remission. Multiple factors including disease severity, joint damage, anxiety/depression and physicians’ agreement on treat-to-target were associated with likelihood of over-reporting of remission by physicians. Under-examination of patients and over-reporting of remission may result in sub-optimal treatment of patients with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/discordance-between-physician-stated-remission-and-28-joint-disease-activity-score-das28-defined-remission-in-rheumatoid-arthritis-patients/