Journal List > J Korean Rheum Assoc > v.15(3) > 1003624

Lee, Lee, and Kang: Defining Remission of Korean Patients with Rheumatoid Arthritis



To define the state of remission based on American College of Rheumatology (ACR) preliminary criteria in Korean patients with rheumatoid arthritis (RA).


A hundred three patients of RA, followed up over 1 year, were selected at Ewha medical center from May 2000 to May 2006. Remission was defined by ACR preliminary criteria. Data were obtained from the initial and the last visit. Data on initial tender joint count (TJC) and swollen joint count (SJC), treatment, disease duration, remission duration were collected. Initial ESR, CRP, rheumatoid factor (RF), TJC and SJC were also performed at the last clinical visit or at the time of remission.


Patients in remission were 35%. The maintenance duration of remission was 4.8±9.0 (mean±SD) months. Remission group had shorter disease duration (20.2±34.7 vs. 58.2±83.2 months, p=0.010), were at earlier stage of the disease (<2 years of symptom onset) (80.6 vs. 52.2%, p=0.006) compared to non-remission group. Percentage of patients showing decrease in RF titer was significantly higher in the remission group compared to the non-remission group (p=0.049). However, seronegative conversion of RF was not related to remission status (15.6 vs. 14.8%). In the non-remission group, pain was the most persistently non-satisfying clinical variable of the ACR preliminary criteria.


Patients at early stage of disease achieved clinical remission in higher rate. Changes of RF titer was affected by clinical remission status.


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Fig. 1.
Distribution of remission duration in remission group is shown by Kaplan-Meier analysis. Patients on remission within 12 months are 36.1% (13/36).
Fig. 2.
Changes in rheumatoid factor titer during the follow up period in RA remission group (A), non-remission group (B).
Table 1.
American College of Rheumatology preliminary criteria for remission (1)
Five or more of the following criteria must be fulfilled
for a least 2 consecutive months
1. Duration of morning stiffness not exceeding 15
2. No fatigue
3. No joint pain by anamnesis
4. No joint tenderness or pain on motion
5. No soft tissue swelling in joints or tendon sheath
6. ESR<30 mm/hr for a female or 20 mm/hr for a male
Table 3.
Remission status of RA patients
Remission, n (%) 36 (35)
No remission, n (%) 67 (65)
Mean duration until remission, mean±SD, 15.6±7.9
<12 months, n (%) 13 (36.1)
12∼24 months, n (%) 16 (44.4)
>24 months, n (%) 7 (19.4)
Mean maintenance duration of remission, 13.8±10.5
mean±SD, months  
<12 months, n (%) 21 (58.3)
>12 months, n (%) 15 (41.7)
Table 2.
Clinical and demographic characteristics of RA patients
Variable n=103
Female, % 83.5
Mean age, years 54.7±14.9
Mean age at onset of RA, years 50.9±14.9
Mean disease duration, months 44.9±72.3
with early arthritis (<2 years), % 62.1
Mean follow-up duration, months 41.7±16.4
Rheumatoid factor positive, % 83.5
Table 4.
Comparison of clinical and demographic characteristics of RA patients according to the state of remission
  Remission (n=36) No remission (n=67) p
Female, % 86.1 82.1 NS
Mean age, years 53.8±14.0 55.2±14.4 NS
Mean disease duration, months 20.2±34.7 58.2±83.2 0.010
With early arthritis (<2years), % 80.6 52.2 0.006
Follow up duration, months 42.3±16.5 41.4±16.5 NS
Rheumatoid factor positive, % 88.9 80.6 NS
Initial titer of rheumatoid factor, IU/mL 290.6 252.4 NS
Mean number of initial tender joint 8.7±8.0 7.1±6.7 NS
Mean number of initial swollen joint 7.3±7.8 5.4±5.5 NS
Initial ESR, mm/hr 38.8±32.5 43.5±28.9 NS
Initial CRP, mg/dL 2.2±4.0 1.9±2.6 NS
Mean number of DMARDs used, no. (range) 2.2 (1∼4) 2.5 (1∼5) NS
Methotrexate, % 97.2 98.5 NS
DMARDs combination therapy, % 86.1 89.6 NS
Table 5.
Comparison of rheumatoid factor changes during the follow up period in seropositive RA patients between the remission group and the nonremission group
Remission n=32 (%) No remission n=54 (%) p
Rheumatoid factor decrease 27 (84.4) 34 (63) 0.049
Rheumatoid factor increase 5 (15.6) 20 (37) 0.049
Seronegative conversion 5 (15.6) 8 (14.8) NS

decrease in rheumatoid factor titer to negative value

Table 6.
Distribution of ACR remission criteria in R patients who did not achieved remission follow up
Criteria Criteria
satisfying, non-satisfying
n (%) n (%)
Morning stiffness <15 min 33 (49.3) 34 (50.7)
No fatigue 43 (64.2) 24 (35.8)
No joint pain 1 (1.5) 66 (98.5)
No tender joint 33 (49.3) 34 (50.7)
No swollen joint 28 (41.8) 39 (58.2)
Normal ESR 53 (79.1) 14 (20.9)


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