Table 1.
Summary of studies comparing subclinical findings between patients with rheumatoid arthritis who fulfil the ACR/EULAR Boolean-based remission criteria and the patients in near-remission
| Study | Context: | Sample characteristics | Definition of ACR/EULAR Boolean Remission, n (%) | Assessment timepoint: | Definition of near-remission, n (%) | Image definition(s) | Comparison of sub-clinical image |
| Paulshus Sundlisæter et al (2022), Norway1 | DMARD-naïve patients participating in an RCT (ARCTIC), 11 centres | Sample: n=203 (62% female; 54 years median age (42–63); 5 months median disease duration (3–11); 69% RF+; 81% ACPA+) | Definition: SJC≤1/44 AND Ritchie Articular Index (RAI)*≤1 AND CRP≤1 AND PGA≤1 Proportion: 112 (55%) |
2 yars after study initiation | SJC≤1/44 and CRP≤1 and RAI>1 and/or PGA>1 Proportion: 61 (30%) |
Ultrasound: 32 joints, using grey scale (GS, 0–96) and synovitis power doppler (PD, 0–96) according to a semi-quantitative scale (0–3) MRI: dominant hand, using OMERACT scoring system (RAMRIS synovitis, 0–21; RAMRIS bone marrow oedema, 0–75; RAMRIS tenosynovitis, 0–42). |
No statistical differences in any score |
| Brites et al (2021), Portugal9 | Observational study, single centre | Sample: n=130 (86% female; 63 years mean age (SD=12); 14 years median disease duration (6-22); 65% RF+; 59% ACPA+) | Definition: SJC≤1/28 and TJC≤1/28 and CRP≤1 and PGA≤1 Proportion: 40 (31%)† |
Cross-sectional study | SJC≤1/28 and TJC≤1/28 and CRP≤1 and PGA>1 Proportion: 40 (31%)† |
Ultrasound: 44 joints, 38 tendons sheaths, and four bursae using grey scale (GS, 0–132) and synovitis power doppler (PD, 0–132) according to a semi-quantitative scale (0–3), and the Global OMERACT-EULAR Synovitis Score (GLOESS, 0–132, primary outcome). | No statistical differences in any score |
| Nakabo et al (2020), Japan10 | Observational study, single centre | Sample: n=402 (81% female; 62 years mean age (SD=13); 13 years mean disease duration (SD=11); 87% RF+; 81% ACPA+) | Definition: same as above Proportion: 118 (29%) |
Cross-sectional study | SJC≤1/28 AND TJC≤1/28 AND CRP≤1 AND PGA>1 Proportion: 141 (35%) |
Ultrasound: 20 joints, using grey scale (GS, 0–60) and synovitis power doppler (PD, 0–60) according to a semiquantitative scale (0–3) | No statistical differences in any score |
*Ritchie Articular Index is a graded assessment of 0–3 of the tenderness (0 no tenderness, +1 patient complained of pain, +2 patient complained of pain and winced, +3 patient complained of pain and winced and withdrew) in 26 joint regions (tempro-mandibular, cervical spine, sternoclavicular, acromioclavicular, shoulder, elbow, wrist, metacarpal-phalangeal, proximal interphalangeal, hip, knee, ankle, talocalcaneal, midtarsal and metatarsal)26
†purposive sample.
ACPA+, anticitrullinated protein/peptide antibody positive; CRP, C reactive protein; DMARD, disease-modifying antirheumatic drugs; GS, grey scale; OMERACT, Outcome Measures in Rheumatology; PGA, Patient Global Assessment of disease activity; RAI, Ritchie Articular Index; RCT, randomised controlled trial; RF+, rheumatoid factor positive; SJC, swollen joint count; TJC, tender joint count.