AB0734C REMISSION IN AXIAL SPONDYLOARTHRITIS: A DELPHI-METHOD QUESTIONNAIRE AMONG EXPERTS TO EVALUATE THE AVAILABLE ASSESSMENT TOOLS TO MEASURE DISEASE ACTIVITY AND TO DEVELOP A CONSENSUS DEFINITION OF REMISSION
Authors: Xavier Juanola-Roura, Eduardo Collantes-Estevez, Jordi Gratacos-Masmitja, Cristina Fernández-Carballido, Pedro Zarco-Montejo
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Several definitions of remission in axial spondyloarthritis (axSpA) have been proposed based on the available disease activity assessment tools, but to date we lack a universally accepted definition of remission for the development of clinical trials or routine clinical practice. <h3>Objectives</h3> To explore the degree of agreement that exists among the experts managing patients with axSpA regarding the assessment tools available to evaluate disease activity in these patients and to develop a consensus definition of clinical remission in axSpA. <h3>Methods</h3> As a consensus method, we followed the modified Delphi methodology. A scientific committee developed 80 statements that were submitted in 2 rounds (in September and October 2018, respectively) to a panel of 152 rheumatologists from GRESSER (GRupo de Estudio de ESpondiloartritis de la Sociedad Española de Reumatología), the Spanish working group with common interests in spondyloarthritis, addressing controversial issues regarding the current assessment of remission; clinical features, laboratory and imaging tests results, and if they should be included in the definition of remission; general recommendations for outpatient visits and the use of disease activity scores. <h3>Results</h3> Agreement was reached for 56 of the 80 proposed items (70%). The panelists concluded that although a definition of remission in axSpA is not currently available, there is consensus that it is possible to achieve remission in this disorder. There was agreement that the definition of remission in axSpA should include: pain, fatigue, functional impairment, mobility, extra-articular manifestations, peripheral involvement, joint inflammation, disease activity, laboratory tests, quality of life, need for treatment, progression of the disease, and both physician and patient global assessments. It is recommended to set a therapeutic goal when starting treatment in patients with axSpA, the ideal objective being remission, but low disease activity (LDA) may also be acceptable as an alternative objective, being aSDAS the preferred tool to assess disease activity with cut-off values of &lt; 1.3 for remission and &gt; 1.3 to &lt; 2.1 for LDA. A proposal for clinical remission in axSpA based on the aSDAS cut-off value associated to the absence of extra-articular (psoriasis, uveitis, inflammatory bowel disease) and peripheral (arthritis, enthesitis, dactylitis) activity, as well as the absence of inflammation assessed by the normalization of CRP levels and absence of radiographic progression. <h3>Conclusion</h3> This work offers consensus recommendations and a proposal of clinical remission that may be useful in the management of patients with axSpA. <h3>Disclosure of interests</h3> Xavier Juanola-Roura: None declared, Eduardo Collantes-Estevez: None declared, Jordi Gratacos-Masmitja Grant/research support from: Pfizer inc, Consultant for: Pfizer inc, Speakers bureau: Pfizer inc, Cristina Fernández-Carballido: None declared, Pedro Zarco-Montejo: None declared