Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis.
10.3346/jkms.2016.31.12.1907
- Author:
Yoon Kyoung SUNG
1
;
Soo Kyung CHO
;
Dam KIM
;
Bo Young YOON
;
Chan Bum CHOI
;
Hoon Suk CHA
;
Jung Yoon CHOE
;
Won Tae CHUNG
;
Seung Jae HONG
;
Jae Bum JUN
;
Young Mo KANG
;
Jinseok KIM
;
Tae Hwan KIM
;
Tae Jong KIM
;
Eunmi KOH
;
Choong Ki LEE
;
Jisoo LEE
;
Shin Seok LEE
;
Sung Won LEE
;
Hye Soon LEE
;
Yeon Ah LEE
;
Sung Hoon PARK
;
Dae Hyun YOO
;
Wan Hee YOO
;
Sang Cheol BAE
Author Information
1. Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. scbae@hanyang.ac.kr
- Publication Type:Original Article
- Keywords:
Arthritis, Rheumatoid;
Remission;
Discordance
- MeSH:
Arthritis;
Arthritis, Rheumatoid*;
Classification;
Consensus;
Fatigue;
Humans;
Judgment*;
Logistic Models;
Observational Study;
Rheumatic Diseases
- From:Journal of Korean Medical Science
2016;31(12):1907-1913
- CountryRepublic of Korea
- Language:English
-
Abstract:
Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician’s clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.
