The importance of achieving remission in patients with rheumatoid arthritis
Authors:
K. Pavelka
Authors‘ workplace:
Revmatologický ústav Praha
Published in:
Čes. Revmatol., 27, 2019, No. 4, p. 218-226.
Category:
Review Article
Overview
According to the recommendations of EULAR/ACR and the Czech Society for Rheumatology, the goal of treatment for each patient with rheumatoid arthritis (RA) is to achieve remission. Alternatively, in patients with long-standing disease to achieve low disease activity. The subject of the first part of this review is to analyze the most commonly used remission definitions, including DAS 28 CRP or DAS 28 ESR, SDAI and CDAI. It is also emphasized that the temporal parameters for assessing remission whether it is a one-time, cumulative achievement or so-called sustained remission (defined as DAS 28 < 2.6 for at least 6 months) must always be reported. The next section discusses the occurrence of remission in routine clinical practice, with evidence being obtained primarily from registries and long-term cohort studies. Therapeutic strategies can also influence the achievement of remission, while the application of the T2T principle clearly increases remission frequency. Factors influencing the achievement of remission have been studied. The most important positive predictors of remission include the use of biological drugs, lower baseline activity, shorter disease duration, biologically naïve patients and some others. In the end, the issue of why to strive for remission at all is discussed. The reasons are: improving the quality of life, improving physical function, reducing cardiovascular risk, reducing the need for major orthopedic interventions, and increasing labor productivity. Finally, some new data is presented suggesting remission for some Janus kinase inhibitors may be more frequent than for TNF inhibitors.
Keywords:
rheumatoid arthritis – treat to target – remission – biological drugs
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Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
2019 Issue 4
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