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Remission in RA is defined as a state of disease activity without any (significant) signs of inflammation. Clinical remission is based on the views of the patient regarding their symptoms, examination of the joints, and results of laboratory tests. The rheumatologist using a variety of instruments that measure disease activity can do this. When the score is below a set value the patient is in a state of remission (e.g. when a Disease Activity Score for rheumatoid arthritis is less than 2.6 a person may considered to be in remission). Clinical remission does not incorporate radiographic, MRI, ultrasound or other imaging outcomes. Sustained remission is a state of remission that is maintained during a longer period of time, e.g. more than 6 months.

In 2010 ACR and EULAR developed new remission criteria for RA resulting in two proposals for more stringent criteria for use in clinical trials: One is a Boolean-based definition (this means: having only two values, usually “true” and “false”), encompassing tender joint count, swollen joint count, CRP and patient global assessment, all at levels less than or equal to 1. The other definition is the Simplified Disease Activity Index ≤ 3.3.

For use in clinical practice, both definitions are suggested without CRP. See: Felson DT, Smolen JS, Wells G, et al. American college of rheumatology/european league against rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann Rheum Dis 2011;70:404-413.

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