{"doi":"10.1002/acr2.11345","title":"Reexamining Remission Definitions in Rheumatoid Arthritis: Considering Disease Activity Score in 28 Joints, C‐Reactive Protein, and Patient Global Assessment","abstract":"Editor’s Note: The editors of the five American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) journals have been reminded by this article by Felson et al that the ACR and EULAR have jointly agreed on various classification criteria, definitions, recommendations, or points to consider that do not always find reflection in manuscripts submitted to the journals. Consequently, in the future, the editors will enforce the use of the products obtained in the course of joint ACR/EULAR activities in all respective articles. For rheumatoid arthritis, this would mean to use the ACR/EULAR classification criteria, remission definitions, and recommendations on what to report in clinical trials and others as pertinent. The same applies to other diseases. There are valid and important reasons why these activities have been set forth by the ACR and EULAR, and therefore the various task forces’ conclusions, which have been endorsed by the ACR and EULAR, should be respected by investigators and administrators. This does not mean other methods could not be used in a study or article, but at the least, the reports should address the methods agreed on by the two organizations. Maintaining uniformity across major publications regarding rheumatoid arthritis remission or other definitions not only allows for more appropriate comparison across analyses but also enhances readers’ ability to interpret results. Author instructions across the five journals will more strongly reflect this requirement. Over the last 30 years, treatment for rheumatoid arthritis (RA) has improved dramatically. By the early 2000s, disease remission had become a realistic goal, although the definition of remission varied widely, making it hard to compare treatment strategies and gauge how often remission occurred. In 2009, the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) created a joint committee charged with recommending a definition of remission. Members of the committee suggested a large number of candidate definitions and, using a data-driven consensus process, statisticians and programmers tested these candidates in a bank of RA trial data to see which definitions performed best in predicting long-term good function and lack of radiographic progression. The committee endorsed a stringent definition using measures from the validated core set of outcome measures. After reviewing analysis results, the committee selected two definitions of remission that were approved by the ACR and EULAR (1). The first was a Boolean version in which, to attain remission, a patient had to have tender and swollen joint counts of less than or equal to 1, a C-reactive protein (CRP) level of less than or equal to 1 mg/dl, and a patient global assessment of arthritis activity of less than or equal to 1 (on a 0-10 scale). The second recommended definition was a Simple Disease Activity Index (SDAI) score of less than or equal to 3.3, a score based on the same core set of outcomes. Although designed and validated in trials, these definitions could help assess treatment success in both trials and clinical practice, and in practice, they could serve as a treat-to-target goal for some patients. Like all developed criteria, the ACR/EULAR 2011 RA remission criteria were labeled as provisionally approved and awaited validation in an independent sample for final approval. Many concerns have arisen since their publication. Among them is the continuing use in trials of Disease Activity Score in 28 Joints (DAS28) thresholds to define remission, questions about the use of the CRP level as an element of remission definitions, and questions about the appropriateness of including patient global assessment in defining RA remission. This editorial will address each of these issues. The DAS28 is a widely used measure of disease activity. An ACR committee that critically evaluated RA disease activity measures for use in the clinical setting found th","journal":"ACR Open Rheumatology","year":2021,"id":214929,"datarank":0.32958368660043297,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.0,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9505,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":728214,"name":"Diane Lacaille","orcid":"0000-0002-4065-4151","position":1,"is_corresponding":false},{"id":267434,"name":"Michael P. LaValley","orcid":"0000-0002-8488-5170","position":2,"is_corresponding":false},{"id":55624,"name":"Daniel Aletaha","orcid":"0000-0003-2108-0030","position":3,"is_corresponding":false},{"id":31266,"name":"David T. Felson","orcid":"0000-0002-2668-2447","position":0,"is_corresponding":true}],"reference_count":20,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:52:51.201033Z","pmid":"34783200","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}