Background/Purpose: The Disease Activity Score (DAS) and the European League Against Rheumatism (EULAR) response criteria are commonly used to describe disease activity in Rheumatoid Arthritis (RA) patients(1). This study investigates the relationship between remission perceived by physicians versus patients according to the EULAR response criteria.

Methods: Consecutive RA patients with high disease activity and/or unfavourable prognostic factors and no prior treatment were investigated. Patients were treated with methotrexate and prednisolone (week 1: 30 mg, week 2: 20  mg, week 3: 15 mg, week 4-8: 10 mg, week 9-12: 7,5 mg). After 12 weeks of treatment the EULAR response was determined, according to the DAS44. Physician perceived remission was defined as a physician global assessment ≤ 20  on a visual analogue scale (VAS), phrased: “How active do you think the rheumatoid arthritis of your patient is today?”. For patient perceived remission the following question was phrased: “Would you say that, at this moment, your disease activity is as good as gone? (yes/no)(2).

Results: In 75 early RA patients the mean (SD) DAS44 decreased from 3.4 (1.2) to 1.5 (1.0) after 12 weeks of therapy. The number of good, moderate and none EULAR responders were 54 (72%), 14 (19%) and 7 (9%) respectively. After 12 weeks 72% of the physicians perceived remission as well as 72% of the patients, see figure 1. The spearman’s rho test showed significant correlations between the EULAR response versus perception of physicians, the EULAR response versus the perception of patients and the perception of patients versus physicians, respectively r=0.645 (p<0.001), r=0.393 (p=0.001) and r=0.267 (p=0.036). In 61% of the good EULAR responders the physician as well as the patient perceived remission, but in 33% only the physician perceived remission, see figure 2. Patients who did not perceive remission had a significantly different mean (SD) DAS44 of 1.4 (0.5) compared to 0.9 (0.5) in the patients who perceived remission (p=0.001). The difference in DAS44 is caused by tender joint count (TJC) and patient global (PG) but not by swollen joint count or erythrocyte sedimentation rate.

Conclusion: There is a significant correlation between EULAR response and both physicians and patients perceived remission in early RA patients. However, 33% of the patients with a good EULAR response and physician perceived remission, perceive no remission themselves. These patients had a significantly higher DAS44, caused by a higher TJC and PG. Literature:

1)       Van Riel et al. Clin Exp Rheumatol 2005 Sep;23:S93-99

2)       Van Tuyl LH et al.,  Ann Rheum Dis 2015 Jun;74(6):1004-10.