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Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis

Title
Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis
Authors
Sung, Yoon-KyoungCho, Soo-KyungKim, DamYoon, Bo YoungChoi, Chan-BumCha, Hoon-SukChoe, Jung-YoonChung, Won TaeHong, Seung-JaeJun, Jae-BumKang, Young MoKim, JinseokKim, Tae-HwanKim, Tae-JongKoh, EunmiLee, Choong KiLee, JisooLee, Shin-SeokLee, Sung WonLee, Hye-SoonLee, Yeon-AhPark, Sung-HoonYoo, Dae-HyunYoo, Wan-HeeBae, Sang-CheolKORONA Investigators
Ewha Authors
이지수
SCOPUS Author ID
이지수scopus
Issue Date
2016
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
ISSN
1011-8934JCR Link1598-6357JCR Link
Citation
vol. 31, no. 12, pp. 1907 - 1913
Keywords
ArthritisRheumatoidRemissionDiscordance
Publisher
KOREAN ACAD MEDICAL SCIENCES
Indexed
SCI; SCIE; SCOPUS; KCI WOS scopus
Abstract
Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician's clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (kappa). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n= 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (kappa= 0.226) and the concordant remission rate was only 5.5% (n= 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.
DOI
10.3346/jkms.2016.31.12.1907
Appears in Collections:
의학전문대학원 > 의학과 > Journal papers
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