Background/Purpose: Definitions for the classification of “remission” have been proposed by ACR/EULAR: Boolean and SDAI<3.3.  These criteria require a formal tender and swollen joint count, a patient global assessment, a C-reactive protein (CRP) and (for SDAI definition) a physician global assessment.  Rheumatologists usually perform a careful joint examination, but do not perform formal joint counts at most visits, and CRP often is missing at the time of the visit.  RAPID3, a patient reported disease activity measure, is correlated significantly with DAS28, CDAI, and other RA indices and can be calculated in less than 5 seconds, compared to 90 seconds to perform a formal joint count.  Simply counting >1 swollen joint can be performed without interfering with usual patient interactions, unlike a full formal joint count.  We sought to analyze the capacity of a novel description of remission in RA using RAPID3 and the presence or absence of greater than 1 swollen joint, and compared results to ACR/EULAR remission.

Methods: All patients (with any diagnosis) in a solo Rheumatology practice are given an MDHAQ to be completed by the patient in the waiting area and RAPID3 is calculated before the patient is seen.  Patients are instructed to obtain standard laboratory tests approximately 1 week prior to the visit, including a CRP, so that CRP values will be available at the time of the visit.  A formal joint count (28 tender/28 swollen) is performed in all RA patients, and, a physician global score is assigned. A random patient visit was selected which included all measures. Patients were identified as in remission or not, according to ACR/EULAR Criteria or “RAPID3RJ” defined as  a RAPID3 score <=3.0 AND ≤1 swollen joint.  Comparisons of the two descriptions were analyzed using Spearman correlations and kappa statistics.

Results: 191 patients with RA were identified.  Complete data were available in 122 patients.   ACR/EULAR remission criteria were met in 27 of 122 patients; RAPIDRJ1 in 23 patients (Table 1).   22 patients were in agreement using both measures; 5 in ACR/EULAR were not in RAPIDRJ, 1 in RAPIDRJ were not in ACR/EULAR.  Spearman rho was 0.86 (p<0.0001); Kappa=0.85 (substantial agreement)

Conclusion: The classification of remission can be made using a simple patient questionnaire and requiring only the identification of ≤1 swollen joint.  Future studies are planned to determine if this new definition of remission will also predict X-ray progression, one of the criteria for the development of the ACR/EULAR criteria.

Table 1

RAPID3≤3 + SWOLLEN JOINT COUNT ≤1   (RAPIDRJ1)	ACR/EULAR REMISSION CRITERIA
	NO	YES	TOTAL
NO	94	5	99
YES	1	22	23
TOTAL	95	27	122

Kappa=0.85    p<10^-4         Spearman rho=0.86

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/significant-correlation-between-acreular-remission-criteria-and-a-simplified-measure-using-rapid3-and-careful-joint-examination-without-a-formal-joint-count/