Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Remission in rheumatoid arthritis: missing objectives by using inadequate DAS28 targets

Nature Reviews Rheumatology volume 15, pages 633–634 (2019)Cite this article

Subjects

For too long, the definition of ‘remission’ in rheumatoid arthritis has been distorted by the widespread use of an inadequate tool, with consequences for clinical care and for making sense of clinical trial data. Has the time come to move away from DAS28-defined remission?

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Distinct effects of different therapies on DAS28-defined remission.

References

  1. Felson, D. T. et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann. Rheum. Dis. 70, 404–413 (2011).

    Article  Google Scholar 

  2. Aletaha, D. & Smolen, J. S. Joint damage in rheumatoid arthritis progresses in remission according to the Disease Activity Score in 28 joints and is driven by residual swollen joints. Arthritis Rheum. 63, 3702–3711 (2011).

    Article  Google Scholar 

  3. Schoels, M. et al. Evaluation of newly proposed remission cut-points for disease activity score in 28 joints (DAS28) in rheumatoid arthritis patients upon IL-6 pathway inhibition. Arthritis Res. Ther. 19, 155 (2017).

    Article  CAS  Google Scholar 

  4. Linde, L. et al. Does clinical remission lead to normalization of EQ-5D in patients with rheumatoid arthritis and is selection of remission criteria important? 37, 285–290 (2010).

  5. Thiele, K. et al. Performance of the 2011 ACR/EULAR preliminary remission criteria compared with DAS28 remission in unselected patients with rheumatoid arthritis. Ann. Rheum. Dis. 72, 1194–1199 (2013).

    Article  Google Scholar 

  6. Smolen, J. S. et al. Brief Report: Remission rates with tofacitinib treatment in rheumatoid arthritis: a comparison of various remission criteria. Arthritis Rheumatol. 69, 728–734 (2017).

    Article  CAS  Google Scholar 

  7. Orange, D. E. et al. Histologic and transcriptional evidence of subclinical synovial inflammation in rheumatoid arthritis patients in clinical remission. Arthritis Rheumatol. 71, 1034–1041 (2019).

    Article  CAS  Google Scholar 

  8. Tanaka, Y. et al. Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study. 74, 389–395 (2015).

  9. Smolen, J. S. et al. Impact of flare on radiographic progression after etanercept continuation, tapering or withdrawal in patients with rheumatoid arthritis. https://doi.org/10.1093/rheumatology/kez224 (2019).

  10. Food and Drug Administration. Rheumatoid arthritis: Developing drug products for treatment [draft guidance document]. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/rheumatoid-arthritis-developing-drug-products-treatment (2013).

Download references

Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria

    Daniel Aletaha & Josef S. Smolen

Authors
  1. Daniel Aletaha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Josef S. Smolen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Daniel Aletaha or Josef S. Smolen.

Ethics declarations

Competing interests

D. Aletaha declares that he has received personal fees from AbbVie, Eli Lilly, Janssen, Medac, Merck Sharp & Dohme, Pfizer, Roche, Sanofi/Genzyme and UCB, and grants from AbbVie, Bristol-Myers Squibb, and Merck Sharp & Dohme. J.S. Smolen declares that he has received grants for his institution from AbbVie, AstraZeneca, Janssen, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer and Roche, and that he has provided expert advice or had symposia speaking engagements for AbbVie, Amgen, AstraZeneca, Astro, Bristol-Myers Squibb, Celgene, Celltrion, Chugai, Gilead, ILTOO, Janssen, Eli Lilly, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi and UCB.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aletaha, D., Smolen, J.S. Remission in rheumatoid arthritis: missing objectives by using inadequate DAS28 targets. Nat Rev Rheumatol 15, 633–634 (2019). https://doi.org/10.1038/s41584-019-0279-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41584-019-0279-6

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing