Rheumatoid arthritis

Stop ‘bitching and whining’ about ACR-EULAR criteria, delegates told

Most people criticising the current ACR/EULAR definition of RA remission are confused over its purpose, delegates have been told.

Opening the session fifty shades of remission in RA, Professor Martin Boers from the Department of Epidemiology & Biostatistics, Amsterdam Rheumatology and Immunology Centre said the ACR-EULAR criteria for remission in rheumatoid arthritis was unpopular with researchers, industry and clinicians because they misunderstood that it is intended for use in trials and not clinical practice.

Researchers and industry did not like the criteria because ACR-EULAR remission was rare and patients who met the criteria could still have subclinical disease activity, he told delegates.

Clinicians disliked the criteria for the same reasons, and because their patients seldom met the definition of remission because of comorbidities such as osteoarthritis or pain syndromes.

And patients also complained about the criteria because there was not enough patient-relevant information.

“When you make a set of definitions and all parties are dissatisfied you know that you have done a great job because you’re right in the middle… everyone has something to bitch and whine about,” he joked.

However, on a more serious note Professor Boers said the general dissatisfaction with the criteria meant researchers were using ‘sub-optimal’ criteria like ‘DAS-remission’ in their clinical trials.

“I’m sure at this meeting you will see hundreds of abstracts with DAS remission, and I put it to you that given that the professional societies have made one definition of remission (ACR/EULAR criteria) all other definitions are not remission,” he stressed.

He implored researchers in the room to stop naming other criteria ‘remission’.

“Call it ‘minimal disease activity’, or ‘happiness’ or whatever you want to call it but do not call anything remission that’s not ACR/EULAR until we as a group decide to change it,” he said.

The professional societies were currently working towards including patient-reported outcomes in the criteria.

But when it came to the clinic Professor Boers said he believed there was currently no need for another definition of remission.

“There is no good evidence that current treatment modalities put substantial proportions of patients really into remission so it’s not a good target,” he said.

“Remission – true absence of disease – is not something we get very often with current therapies… when we get a new generation of great therapies and that target is becoming a possibility then everyone may like the ACR/EULAR definition,” he added.

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