Ab0208 comparison of performance of acr eular 2022 remission criteria in patients with rheumatoid arthritis from india

Background Remission is a state, not change or transition with absence of disease activity in rheumatoid arthritis (RA) [1]. Remission at 6 months has been shown to predict future good outcomes such as arresting radiographic progression and better functional status at 12 and 24 months [2]. ACR EULAR have endorsed Boolean2.0 in the revised remission criteria in 2022 [3]. None of these participants were recruited from India. In this ongoing study, we compare the various remission criteria in patients with RA in our setting. Objectives To compare the performance of various remission criteria (Disease Activity Score 28 (DAS28 ESR), Disease activity Score 28 CRP (DAS28 CRP), Simple Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Boolean, Boolean2.0, and BooleanX) in patients with RA presenting to our rheumatology clinic, at Jodhpur, India. Methods A longitudinal study was initiated in July 2021 after Ethics Committee approval. Demographic and treatment details were collected after written informed consent. Remission criteria were calculated at 6 months follow up. We analysed agreement between the Boolean- and index-based criteria SDAI, CDAI, DAS28 ESR and DAS28 CRP. The study is an ongoing study, with a calculated sample size of 165. Results Follow-up data of 85 participants of which 85.9% female with median age of 47 (12) years with RA diagnosed by ACR EULAR 2010 were collected. At enrolment, 10.6% (n = 9) were on biologicals, 35.3% (n = 30) on methotrexate alone and 54.1% (n = 46) on combination Disease-modifying Antirheumatic Drugs (DMARDs) therapy and at 6 months, 5.9% (n = 5) were on biologicals, 61.17% (n = 52) on methotrexate alone and 32.9% (n = 28) on combination DMARDs therapy. The proportion of patients in remission at 6 months using DAS28 ESR was 65.9% (n = 56), DAS28 CRP was 54.1% (n = 46), SDAI was 38.8% (n = 33), CDAI was 32.9% (n = 28), Boolean was 10.6% (n = 9), Boolean2.0 was 40% (n = 34) and BooleanX was 47.1% (n = 40) (Figure 1). DAS28 CRP showed substantial agreement with Boolean2.0 (kappa 0.63) at enrolment and moderate agreement (kappa 0.49) at 6 months, however, SDAI had only slight agreement with modified Boolean based indices (Table 1). Table 1. Agreement between modified Boolean indices and disease activity Kappa SDAI at enrolment (CI) SDAI at 6 months (CI) DAS28 CRP at enrolment (CI) DAS28 CRP at 6 months (CI) Boolean 0.23 (0.00-0.08) 0.09 (0.20-0.38) 0.10 (0.09-0.23) 0.15 (0.00-0.03) Boolean2.0 0.13 (0.13-0.29) 0.08 (0.27-0.45) 0.63 (0.00-0.03) 0.49 (0.00-0.03) BooleanX 0.03 (0.97-1.00) 0.06 (0.39-0.59) 0.71(0.00-0.03) 0.39 (0.00-0.03) Conclusion This study provides evidence of external validation of the newly proposed modification of the Boolean ACR/EULAR remission criteria; however, we found that the Boolean2.0 criteria did not exhibit agreement with index-based remission definitions in the Indian population from our centre. Our results replicate the findings that a Boolean definition using 2 cm as threshold for patient global assessment of disease activity (Boolean2.0) yields better agreement than Boolean [2]. With the validation Boolean2.0 in our settings, our data support the revised ACR/EULAR remission criteria as a target in clinical practice. References [1]Felson DT, Anderson JJ, Boers M, Bombardier C, Chernoff M, Fried B, et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum. 1993 Jun;36(6):729–40. [2]Studenic P, Felson D, Wit M de, Alasti F, Stamm TA, Smolen JS, et al. Testing different thresholds for patient global assessment in defining remission for rheumatoid arthritis: are the current ACR/EULAR Boolean criteria optimal? Ann Rheum Dis. 2020 Apr 1;79(4):445–52. [3]Studenic P, Aletaha D, de Wit M, Stamm TA, Alasti F, Lacaille D, et al. American College of Rheumatology/EULAR Remission Criteria for Rheumatoid Arthritis: 2022 Revision. Arthritis Rheumatol. 2023;75(1):15–22. Acknowledgements: NIL. Disclosure of Interests None Declared.