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The controversy of using PGA to define remission in RA

Nature Reviews Rheumatology volume 14, page 245 (2018)Cite this article

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We thank Ferreira and colleagues for their correspondence (The controversy of using PGA to define remission in RA. Nat. Rev. Rheumatol https://doi.org/nrrheum.2018.35 (2018))1 regarding our commentary (van Tuyl, L. H. D. & Boers, M. Remission — keeping the patient experience front and centre. Nat. Rev. Rheumatol. 13, 573–574 (2017))2,3. Ferreira and colleagues once again advocate removal of patient global assessment (PGA) from the remission criteria by creating two separate targets: a measure of inflammatory activity (physician's perspective) responsive to immunosuppressive therapy, and a measure of disease impact (patient's perspective). For the former, they proposed the 3v-remission (which is the current remission criteria minus the PGA requirement).

Ferreira and colleagues argue that PGA “has no more than a weak correlation with disease activity”, without citing evidence. We have evidence to the contrary (as discussed here and in our original commentary2), but first note that they seem to mix the concepts of 'inflammatory activity' and 'disease activity'. The former has to our knowledge not been properly defined. Do the authors refer to joint inflammatory activity, systemic inflammatory activity or both? If the former, an argument can be made to look only at the joints, but perhaps clinical assessments are then not sufficient; if the latter, the inclusion of acute phase reactants is reasonable. However, neither fully encompasses the construct of disease activity, which is broader than inflammatory activity, as defined in the core set of outcome measures developed by the Outcome Measures in Rheumatology Clinical Trials (OMERACT) group and other groups in the early 1990s4,5,6.

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References

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Authors and Affiliations

  1. Amsterdam Rheumatology and Immunology Centre, VU University Medical Center, Amsterdam, Netherlands

    Lilian H. D. van Tuyl

  2. Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands

    Maarten Boers

Authors
  1. Lilian H. D. van Tuyl
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  2. Maarten Boers
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Both authors researched data for the article, wrote the article, made substantial contributions to discussion of its content and reviewed and/or edited the manuscript before submission.

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Correspondence to Lilian H. D. van Tuyl.

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van Tuyl, L., Boers, M. The controversy of using PGA to define remission in RA. Nat Rev Rheumatol 14, 245 (2018). https://doi.org/10.1038/nrrheum.2018.36

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