Elsevier

Joint Bone Spine

Volume 83, Issue 2, March 2016, Pages 117-119
Joint Bone Spine

Editorial
Remission in axial spondyloarthritis: The ultimate treatment goal?

https://doi.org/10.1016/j.jbspin.2015.08.015Get rights and content

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Defining disease remission

A remission is neither a full recovery nor the patient acceptable symptom state (PASS) [4], [5]. Instead, a remission is a state of little or no activity, during which no disease progression occurs. Several definitions based on different tools have been put forward.

In 2001, the Assessment in Spondyloarthritis International Society (ASAS) suggested a preliminary definition of a partial remission [6] as a value no greater than 2 on 0–10 visual analog scales (VASs) for the following four domains:

The various dimensions used to define a remission have limitations

Absence of significant clinical evidence of inflammatory activity may correspond to complete relief from back pain in axial spondyloarthritis. However, the extraarticular manifestations also deserve attention. For instance, absence of rheumatic symptoms in a patient with recurrent uveitis probably does not indicate a remission.

Resolution of the systemic inflammation indicating a biological remission is clearly required. Nevertheless, systemic inflammation is lacking in some patients with

Remission as a tool for evaluating treatments

Various remission endpoints have been used in controlled treatment trials. In a trial of patients with axial spondyloarthritis whose endpoint was either a partial remission or inactive disease based on the ASDAS-CRP, the treatment response rate was up to one-third with NSAIDs and 50% in those given TNFα antagonists, with the highest rates occurring in the subgroups with recent-onset disease [12].

If achieving a remission defined according to any of the available methods is a realistic treatment

Conclusion

Many questions remain unanswered. To date, the window of opportunity concept has not been validated in axial spondyloarthritis. Furthermore, the definitions of a remission and the criteria used to evaluate structural progression may not be well suited to the problems raised by axial spondyloarthritis. Similarly, for close patient monitoring aimed at allowing optimal treatment adjustment, there is no clear definition of a flare (the opposite of a remission) [16]. The concepts that have been

Funding

None.

Disclosure of interest

Lasting or permanent connections: none.

Occasional interventions: AbbVie, BMS, MSD, Pfizer, Roche Chugai, Amgen, Nordic Pharma, UCB, SOBI, Sanofi Aventis, and Novartis.

Indirect interests: Abbvie, Pfizer, Roche Chugai, and MSD.

References (17)

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Cited by (10)

  • Evaluating remission and low disease activity from the perspective of the patient with axial spondyloarthritis: The cross-sectional ConREspAx study

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    To our knowledge, such an approach has only been taken by Godfrin et al., who found low agreement between the patient's and the rheumatologist's perception of remission (kappa = 0.55), which was based on a single question [16,17]. Our approach previously has been used in an international study of patients with psoriatic arthritis [13], although data are scarce in patients with axSpA, where the concept of remission is constantly debated [18,19]. Given that the question was answered by all the patients, our findings confirm the feasibility of evaluating remission and LDA as perceived by the patient based on a single question.

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  • 2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis

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  • 2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis

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    This recommendation falls within the concept of “treat to target” (T2T), which has been advocated for axial SpA and PsA [30]. Control of disease activity as evidenced or demonstrated by remission [31,32] or low disease activity is a known factor for good outcomes. This T2T notion goes hand-in-hand with that of “tight control”.

  • Remission in axial spondyloarthritis: Developing a consensus definition

    2021, Reumatologia Clinica
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    However, the state of ‘inactive disease’ does not always correspond to the remission of the disease. For example, a patient with absence of joint symptoms who presents with recurrent flares of uveitis should not be considered in remission6 and attention must be paid to extra-articular manifestations.14 As mentioned before, inactivity of the extra-articular manifestations is also highlighted as a treatment target.3

  • Treat to Target in Axial Spondyloarthritis: Pros, Cons, and Future Directions

    2020, Rheumatic Disease Clinics of North America
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    Remission refers to the absence of clinical or laboratory evidence of significant inflammatory disease over a prolonged period of time.24 It also has been defined as a state in which the disease does not progress.25,26 In clinical trials, the disease activity states of either inactive disease (ASDAS <1.3) or ASAS partial remission (a value <20 on a scale of 0–100 in all 4 ASAS domains) is used.

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