How Is Rheumatoid Arthritis Remission Defined?

Applications in Clinical Trials and Clinical Practice

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Rheumatoid arthritis is a chronic, autoimmune, inflammatory, potentially disabling type of arthritis which affects 1.5 million American adults. The disease can be associated with joint pain, joint deformity, decreased physical function, as well as systemic effects. The degree of severity depends on the individual but, regardless, the goal is to slow disease progression and stave off disability. 

When a diagnosis of rheumatoid arthritis is established, a treatment plan is immediately developed.

In addition to managing symptoms of the disease, the ultimate goal of treatment is to help the patient achieve remission.

Biologic drugs, which first came on the scene in 1998, made remission an attainable goal. While some rheumatoid arthritis patients were able to achieve remission prior to the availability of biologic drugs, most did not. Biologic drugs had more advanced targets in the body and with that, the possibility of remission became a more realistic goal.

The advancement to biologics was not in line, though, with the definition of remission that had been created in 1981 by the American College of Rheumatology (ACR). The American College of Rheumatology recognized a need to update the 1981 definition. Not only does the updated remission definition give researchers clearer standards in clinical trials, it gives patients the sense that remission is achievable and gives them perspective about when remission occurs.

In 1981, remission was defined as elimination of all disease. The updated definitions for remission are more specific.

The Updated Rheumatoid Arthritis Remission Definition

The American College of Rheumatology and European League Against Rheumatism analyzed clinical trial data and surveyed committee members before deciding on two definitions for rheumatoid arthritis remission which primarily apply to use in clinical trials.

Definition 1

To be considered in remission, a clinical trial participant would need to have:

  • Tender joint count - less than or equal to 1
  • Swollen joint count - less than or equal to 1
  • C-reactive protein - less than or equal to 1 mg/dl
  • Patient global assessment score - less than or equal to 1 on a 0 to 10 scale

CRP or C-reactive protein is a specific protein produced in the liver which is elevated in the presence of acute inflammation or infection.

Definition 2

Utilizes the Simplified Disease Activity Index, which includes the criteria listed above plus a physician global assessment, added together. On a scale from 0 to 10, remission is less than or equal to 3.3.

Patient global assessment refers to how a patient feels they are doing. The physician global assessment refers to how the physician feels the patient is doing.

The Bottom Line

The aforementioned updated definitions have application in clinical trials. Researchers must consider if the definitions also have application in clinical practice.

The American College of Rheumatology classification criteria for determining clinical remission in clinical practice (1981) include:

  • morning stiffness less than or equal to 15 minutes
  • no fatigue
  • no joint pain
  • no joint tenderness or pain on motion
  • no soft tissue swelling in joints or tendon sheaths
  • erythrocyte sedimentation rate (a blood test which measures nonspecific inflammation) less than or equal to 30 in females and 20 in males


Rheumatoid Arthritis Researchers Redefine Remission. American College of Rheumatology. February 3, 2011.

Preliminary Criteria for Clinical Remission in Arthritis. Arthritis and Rheumatism. Pinals RS et al., October 1981.

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