The ultimate goal of treating rheumatoid arthritis is achieving remission. The American College of Rheumatology and the European League Against Rheumatism – organizations created by physicians for the study, research, and education of rheumatic diseases – define “remission” in clinical practice as the patient having all of the following:
- Tender joints < 1 (one or less)
- Swollen joints < 1
- Patient global assessment < 1 (how a patient usually feels on a scale of 0-10, where 0 means the patient feels great and 10 means the patient has pain, stiffness, and is unable to perform daily activities)
For patients, this translates to a CDAI (Clinical Disease Activity Index) score of < 1. This is a questionnaire, including a physical exam, that calculates a scoring of disease activity. Remission is defined as a CDAI score of £ 2.8. The criteria are created for clinical trials, but clinicians should also follow the path for helping patients achieve remission. I have started using this index for some patients since the beginning of 2011, and it has helped to guide treatment for many of them.
So, now we don’t only strive to give patients better quality of life, but we also want to stop the progression of disease and the development of deformities or crippling damage.
Adahli E. Massey, MD, FACR
Ref: The Rheumatology Report Summer 2011