Accepted for Publication in Arthritis Care and Research ...



For non-commercial use onlyAccepted for Publication in Arthritis Care and Research 9th August 2016Available online at: : Hamann, P., Holland, R., Hyrich, K., Pauling, J. D., Shaddick, G., Nightingale, A. and McHugh, N. (2016), Factors Associated with Sustained Remission in Rheumatoid Arthritis in Patients Treated with Anti-Tumour Necrosis Factor (anti-TNF). Arthritis Care & Research. Accepted Author Manuscript. doi:10.1002/acr.23016Factors Associated with Sustained Remission in Rheumatoid Arthritis in Patients Treated with Anti-Tumour Necrosis Factor (anti-TNF)Authors:Dr Philip Hamann (Corresponding Author)1. Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY 2. Royal United Hospitals, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RLEmail: pdhh20@bath.ac.ukDegrees: BMBS, BMedSciDr Richard Holland1. Royal United Hospitals, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RLDegrees: MBChBProfessor Kimme Hyrich1. Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK2. NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK.Degrees: MD PhD FRCPCDr John D Pauling1. Royal United Hospitals, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL2. Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY Degrees: BMedSci BMBS FRCP(Rheumatology) PhDDr Gavin Shaddick1. Department of Mathematical Sciences, University of Bath, Claverton Down, Bath, BA2 7AYDegrees: BSc, MSc and PhDDr Alison Nightingale1. Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AYDegrees: PhDProfessor Neil McHugh1. Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AYDegrees: MBChBFinancial Disclosure Statement:Professor Hyrich has received honoraria of less than $10,000 from Pfizer and Abbvie. None of the other authors have any conflicts of interest to declare.Abstract Objectives. Anti-tumour necrosis factor antibody (anti-TNF) has revolutionised the treatment of rheumatoid arthritis (RA) and remission is now a realistic possibility for patients. Despite widespread use of anti-TNFs, predicting which patients are most likely to attain a sustained good response to these treatments remains challenging. Our objective was to undertake a systematic review of the literature to evaluate existing evidence for demographic and clinical factors associated with the achievement of sustained remission in individuals with RA treated with anti-TNF.Methods. EMBASE, MEDLINE and the Cochrane Controlled Trials Register were searched along with studies identified from reference lists. Quality of studies was assessed using Newcastle-Ottawa criteria. Meta-analysis was undertaken where unadjusted odds ratios were available for the same demographic or clinical factors from at least three studies.Results. Six studies were identified. Concomitant methotrexate use was associated with an increased likelihood of achieving sustained remission. Greater baseline disease activity, tender joint count, age, disease duration, baseline functional impairment and female gender were associated with reduced likelihood of achieving sustained remission. Conclusions. Factors predicting sustained remission are seldom reported. Evidence identified in this review supports current recommendations for methotrexate co-prescription and highlights the negative impact of particular clinical and demographic features on the likelihood of achieving optimal response to anti-TNF treatment. Sustained remission is clinically more relevant than point remission in RA. More widespread reporting of sustained remission will help clinicians set realistic expectations on likely long-term treatment efficacy and could be an important tool for identifying patients suitable for dose optimisation. Significance and InnovationDemographic and clinical features can help to predict sustained remission with anti-TNF. Female gender is associated with a reduced likelihood of achieving sustained remission.Methotrexate co-prescription with anti-TNF is associated with an increased likelihood of achieving sustained remission.Aggressive treat-to-target strategies, alongside increased use of biologic agents such as anti-tumour necrosis factor antibody (anti-TNF) ADDIN PAPERS2_CITATIONS <citation><uuid>1DD16821-C67F-40AD-8165-14DD15733676</uuid><priority>0</priority><publications><publication><volume>364</volume><publication_date>99200407001200000000220000</publication_date><number>9430</number><doi>10.1016/S0140-6736(04)16676-2</doi><startpage>263</startpage><title>Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial</title><uuid>E36EBE1F-6A80-4D95-B25D-2C92C019A0F3</uuid><subtype>400</subtype><endpage>269</endpage><type>400</type><url> Ltd</publisher><title>The Lancet</title><type>-100</type><subtype>-100</subtype><uuid>3815CD23-96AA-4F29-A856-9D7A36841BE7</uuid></publication></bundle><authors><author><firstName>Catriona</firstName><lastName>Grigor</lastName></author><author><firstName>Hilary</firstName><lastName>Capell</lastName></author><author><firstName>Anne</firstName><lastName>Stirling</lastName></author><author><firstName>Alex</firstName><middleNames>D</middleNames><lastName>McMahon</lastName></author><author><firstName>Peter</firstName><lastName>Lock</lastName></author><author><firstName>Ramsay</firstName><lastName>Vallance</lastName></author><author><firstName>Duncan</firstName><lastName>Porter</lastName></author><author><firstName>Wilma</firstName><lastName>Kincaid</lastName></author></authors></publication><publication><volume>52</volume><publication_date>99200500001200000000200000</publication_date><number>11</number><doi>10.1002/art.21405</doi><startpage>3381</startpage><title>Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): A randomized, controlled trial</title><uuid>B5166D58-F8C2-47FA-A970-51D460FE2D69</uuid><subtype>400</subtype><endpage>3390</endpage><type>400</type><url> Rheum.</title><type>-100</type><subtype>-100</subtype><uuid>1783B05B-2142-4262-874F-B3F55A813303</uuid></publication></bundle><authors><author><firstName>Y</firstName><middleNames>P M</middleNames><lastName>Goekoop-Ruiterman</lastName></author><author><lastName>Vries-Bouwstra</lastName><nonDroppingParticle>de</nonDroppingParticle><firstName>J</firstName><middleNames>K</middleNames></author><author><firstName>C</firstName><middleNames>F</middleNames><lastName>Allaart</lastName></author><author><nonDroppingParticle>van</nonDroppingParticle><firstName>D</firstName><lastName>Zeben</lastName></author><author><firstName>P</firstName><middleNames>J S M</middleNames><lastName>Kerstens</lastName></author><author><firstName>J</firstName><middleNames>M W</middleNames><lastName>Hazes</lastName></author><author><firstName>A</firstName><middleNames>H</middleNames><lastName>Zwinderman</lastName></author><author><firstName>H</firstName><middleNames>K</middleNames><lastName>Ronday</lastName></author><author><firstName>K</firstName><middleNames>H</middleNames><lastName>Han</lastName></author><author><firstName>M</firstName><middleNames>L</middleNames><lastName>Westedt</lastName></author><author><firstName>A</firstName><middleNames>H</middleNames><lastName>Gerards</lastName></author><author><lastName>Groenendael</lastName><nonDroppingParticle>van</nonDroppingParticle><firstName>J</firstName><middleNames>H L M</middleNames></author><author><firstName>W</firstName><middleNames>F</middleNames><lastName>Lems</lastName></author><author><lastName>Krugten</lastName><nonDroppingParticle>van</nonDroppingParticle><firstName>M</firstName><middleNames>V</middleNames></author><author><firstName>F</firstName><middleNames>C</middleNames><lastName>Breedveld</lastName></author><author><firstName>B</firstName><middleNames>A C</middleNames><lastName>Dijkmans</lastName></author></authors></publication></publications><cites></cites></citation>(1,2), have improved outcomes for patients with rheumatoid arthritis (RA) and the aim of achieving sustained remission is a realistic aspiration. Response to anti-TNF, however, remains variable and requires further investigation. Waiting to assess efficacy of anti-TNF is time-consuming, often taking months for clinicians and patients to identify that the treatment is not working, and can be frustrating if anticipated clinical improvements do not materialise. Unsuccessful trials of anti-TNF therapy in RA also have important healthcare cost implications. Understanding how the demographic and clinical features of a patient may influence the likelihood of achieving sustained remission with anti-TNF will help physicians personalise treatment strategies and might enable patients to achieve sustained remission sooner through early choice of drug that offers the best likelihood of success.The majority of published studies report remission rates at a single time point, or sequential point remission rates. It may be unclear whether the proportion of patients identified in remission at sequential time points are the same patients, or are a varying group of individuals, with some patients moving in and out of remission over time. European League Against Rheumatism (EULAR) guidance ADDIN PAPERS2_CITATIONS <citation><uuid>49C16829-CD68-48DC-B3BD-FBD961D561C4</uuid><priority>0</priority><publications><publication><uuid>7A539BB0-3737-44A8-B7A7-EFB19A89E3B6</uuid><volume>73</volume><doi>10.1136/annrheumdis-2013-204573</doi><startpage>492</startpage><publication_date>99201403001200000000220000</publication_date><url> recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, , Vienna, Austria.</institution><number>3</number><subtype>420</subtype><endpage>509</endpage><bundle><publication><title>Annals of the rheumatic diseases</title><type>-200</type><subtype>-200</subtype><uuid>0B65C418-9168-4FDB-A64C-70655364111A</uuid></publication></bundle><authors><author><firstName>Josef</firstName><middleNames>S</middleNames><lastName>Smolen</lastName></author><author><firstName>Robert</firstName><lastName>Landewé</lastName></author><author><firstName>Ferdinand</firstName><middleNames>C</middleNames><lastName>Breedveld</lastName></author><author><firstName>Maya</firstName><lastName>Buch</lastName></author><author><firstName>Gerd</firstName><lastName>Burmester</lastName></author><author><firstName>Maxime</firstName><lastName>Dougados</lastName></author><author><firstName>Paul</firstName><lastName>Emery</lastName></author><author><firstName>Cécile</firstName><lastName>Gaujoux-Viala</lastName></author><author><firstName>Laure</firstName><lastName>Gossec</lastName></author><author><firstName>Jackie</firstName><lastName>Nam</lastName></author><author><firstName>Sofia</firstName><lastName>Ramiro</lastName></author><author><firstName>Kevin</firstName><lastName>Winthrop</lastName></author><author><nonDroppingParticle>de</nonDroppingParticle><firstName>Maarten</firstName><lastName>Wit</lastName></author><author><firstName>Daniel</firstName><lastName>Aletaha</lastName></author><author><firstName>Neil</firstName><lastName>Betteridge</lastName></author><author><firstName>Johannes</firstName><middleNames>W J</middleNames><lastName>Bijlsma</lastName></author><author><firstName>Maarten</firstName><lastName>Boers</lastName></author><author><firstName>Frank</firstName><lastName>Buttgereit</lastName></author><author><firstName>Bernard</firstName><lastName>Combe</lastName></author><author><firstName>Maurizio</firstName><lastName>Cutolo</lastName></author><author><firstName>Nemanja</firstName><lastName>Damjanov</lastName></author><author><firstName>Johanna</firstName><middleNames>M W</middleNames><lastName>Hazes</lastName></author><author><firstName>Marios</firstName><lastName>Kouloumas</lastName></author><author><firstName>Tore</firstName><middleNames>K</middleNames><lastName>Kvien</lastName></author><author><firstName>Xavier</firstName><lastName>Mariette</lastName></author><author><firstName>Karel</firstName><lastName>Pavelka</lastName></author><author><lastName>Riel</lastName><nonDroppingParticle>van</nonDroppingParticle><firstName>Piet</firstName><middleNames>L C M</middleNames></author><author><firstName>Andrea</firstName><lastName>Rubbert-Roth</lastName></author><author><firstName>Marieke</firstName><lastName>Scholte-Voshaar</lastName></author><author><firstName>David</firstName><middleNames>L</middleNames><lastName>Scott</lastName></author><author><firstName>Tuulikki</firstName><lastName>Sokka-Isler</lastName></author><author><firstName>John</firstName><middleNames>B</middleNames><lastName>Wong</lastName></author><author><nonDroppingParticle>van der</nonDroppingParticle><firstName>Desirée</firstName><lastName>Heijde</lastName></author></authors></publication></publications><cites></cites></citation>(3) recommends achieving remission as early as possible with consideration of tapering anti-TNF agents if sustained remission is achieved, and Outcome Measures in Rheumatology (OMERACT) define the duration of sustained remission as six months ADDIN PAPERS2_CITATIONS <citation><uuid>46F51090-99A9-40FE-898E-DCC459F8D4F8</uuid><priority>0</priority><publications><publication><startpage>1</startpage><title>The OMERACT Handbook</title><uuid>485C07D3-DC1C-4BBB-AB57-769070F00BDE</uuid><subtype>713</subtype><endpage>124</endpage><type>700</type><publication_date>99201505191200000000222000</publication_date><authors><author><firstName>M</firstName><lastName>Boers</lastName></author><author><firstName>J</firstName><middleNames>R</middleNames><lastName>Kirwan</lastName></author><author><firstName>P</firstName><lastName>Tugwell</lastName></author></authors></publication></publications><cites></cites></citation>(4). Previous systematic reviews have only investigated predictors of point remission in RA ADDIN PAPERS2_CITATIONS <citation><uuid>C68B7184-A8E6-451B-9491-A9B56B8F5187</uuid><priority>0</priority><publications><publication><uuid>31F84319-4E61-4116-951E-EA56799E4015</uuid><volume>62</volume><doi>10.1002/acr.20188</doi><startpage>1128</startpage><publication_date>99201003161200000000222000</publication_date><url> for remission in rheumatoid arthritis patients: A systematic review</title><number>8</number><subtype>400</subtype><endpage>1143</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Wanruchada</firstName><lastName>Katchamart</lastName></author><author><firstName>Sindhu</firstName><lastName>Johnson</lastName></author><author><firstName>Hsing-Ju</firstName><middleNames>Lucy</middleNames><lastName>Lin</lastName></author><author><firstName>Veerapong</firstName><lastName>Phumethum</lastName></author><author><firstName>Carine</firstName><lastName>Salliot</lastName></author><author><firstName>Claire</firstName><lastName>Bombardier</lastName></author></authors></publication></publications><cites></cites></citation>(5), however, given the chronicity of a condition such as RA and the long-term benefits of remission, a durable positive response to anti-TNF is a more clinically relevant outcome.Our objective was to undertake a systematic review of the literature to evaluate the existing evidence for demographic and clinical factors associated with the achievement of sustained remission in individuals with RA treated with anti-TNF.Patients and MethodsThe systematic review protocol was registered prospectively with the PROSPERO database ( HYPERLINK "" , reference CRD42015015983). PRISMA-P ADDIN PAPERS2_CITATIONS <citation><uuid>A2C63382-737D-49A5-BB99-67D0B60EDACA</uuid><priority>0</priority><publications><publication><uuid>29D872D4-9D9F-4947-BC8C-F157749D010C</uuid><volume>4</volume><accepted_date>99201411261200000000222000</accepted_date><doi>10.1186/2046-4053-4-1</doi><startpage>1</startpage><publication_date>99201500001200000000200000</publication_date><url> reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201408271200000000222000</submission_date><number>1</number><institution>Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada. dmoher@ohri.ca.</institution><subtype>400</subtype><bundle><publication><title>Systematic reviews</title><type>-100</type><subtype>-100</subtype><uuid>074421AD-065D-4508-A647-E09E9A506291</uuid></publication></bundle><authors><author><firstName>David</firstName><lastName>Moher</lastName></author><author><firstName>Larissa</firstName><lastName>Shamseer</lastName></author><author><firstName>Mike</firstName><lastName>Clarke</lastName></author><author><firstName>Davina</firstName><lastName>Ghersi</lastName></author><author><firstName>Alessandro</firstName><lastName>Liberati</lastName></author><author><firstName>Mark</firstName><lastName>Petticrew</lastName></author><author><firstName>Paul</firstName><lastName>Shekelle</lastName></author><author><firstName>Lesley</firstName><middleNames>A</middleNames><lastName>Stewart</lastName></author><author><lastName>PRISMA-P Group</lastName></author></authors></publication></publications><cites></cites></citation>(6) and PRISMA ADDIN PAPERS2_CITATIONS <citation><uuid>F540DBB0-CD44-4F1E-BD76-4E51B589B249</uuid><priority>0</priority><publications><publication><uuid>2C3AA2E5-D498-4517-87B6-5111F02D9C20</uuid><volume>6</volume><doi>10.1371/journal.pmed.1000097</doi><startpage>e1000097</startpage><publication_date>99200907211200000000222000</publication_date><url> reporting items for systematic reviews and meta-analyses: the PRISMA statement.</title><publisher>Public Library of Science</publisher><institution>Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. dmoher@ohri.ca</institution><number>7</number><subtype>717</subtype><bundle><publication><title>PLoS medicine</title><type>-100</type><subtype>-100</subtype><uuid>EB233404-9C9D-4869-B913-EC4624BF40B0</uuid></publication></bundle><authors><author><firstName>David</firstName><lastName>Moher</lastName></author><author><firstName>Alessandro</firstName><lastName>Liberati</lastName></author><author><firstName>Jennifer</firstName><lastName>Tetzlaff</lastName></author><author><firstName>Douglas</firstName><middleNames>G</middleNames><lastName>Altman</lastName></author><author><lastName>PRISMA Group</lastName></author></authors></publication></publications><cites></cites></citation>(7) recommendations were followed in the development and implementation of the review.Inclusion criteriaTo be included in the review, papers had to meet the following criteria: 1) Phase three or four clinical trials, long-term extension trials or cohort studies reported as original research in the form of journal papers; 2) Adults (≥18 years of age) with RA according to ACR 1987 ADDIN PAPERS2_CITATIONS <citation><uuid>A6B00AA7-85AC-4ED3-B941-53BD9311484C</uuid><priority>0</priority><publications><publication><volume>31</volume><publication_date>99198803001200000000220000</publication_date><number>3</number><institution>American Rheumatism Association, Atlanta, GA 30329.</institution><startpage>315</startpage><title>The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.</title><uuid>12A7641E-DC94-416E-BE3A-8D3562F1C239</uuid><subtype>400</subtype><endpage>324</endpage><type>400</type><url> Rheum.</title><type>-100</type><subtype>-100</subtype><uuid>1783B05B-2142-4262-874F-B3F55A813303</uuid></publication></bundle><authors><author><firstName>F</firstName><middleNames>C</middleNames><lastName>Arnett</lastName></author><author><firstName>S</firstName><middleNames>M</middleNames><lastName>Edworthy</lastName></author><author><firstName>D</firstName><middleNames>A</middleNames><lastName>Bloch</lastName></author><author><firstName>D</firstName><middleNames>J</middleNames><lastName>McShane</lastName></author><author><firstName>J</firstName><middleNames>F</middleNames><lastName>Fries</lastName></author><author><firstName>N</firstName><middleNames>S</middleNames><lastName>Cooper</lastName></author><author><firstName>L</firstName><middleNames>A</middleNames><lastName>Healey</lastName></author><author><firstName>S</firstName><middleNames>R</middleNames><lastName>Kaplan</lastName></author><author><firstName>M</firstName><middleNames>H</middleNames><lastName>Liang</lastName></author><author><firstName>H</firstName><middleNames>S</middleNames><lastName>Luthra</lastName></author></authors></publication></publications><cites></cites></citation>(8) or ACR/EULAR 2010 ADDIN PAPERS2_CITATIONS <citation><uuid>A7E3EED2-E744-46CB-AE43-FCD0DC317943</uuid><priority>0</priority><publications><publication><uuid>B7E295C5-365F-40C4-AB18-130FE2543D05</uuid><volume>69</volume><doi>10.1136/ard.2010.138461</doi><startpage>1580</startpage><publication_date>99201009001200000000220000</publication_date><url> rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>Arthritis Research UK, Copeman House, Chesterfield, UK. a.silman@</institution><number>9</number><subtype>400</subtype><endpage>1588</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><lastName>Aletaha</lastName></author><author><firstName>Tuhina</firstName><lastName>Neogi</lastName></author><author><firstName>Alan</firstName><middleNames>J</middleNames><lastName>Silman</lastName></author><author><firstName>Julia</firstName><lastName>Funovits</lastName></author><author><firstName>David</firstName><middleNames>T</middleNames><lastName>Felson</lastName></author><author><firstName>Clifton</firstName><middleNames>O</middleNames><lastName>Bingham</lastName></author><author><firstName>Neal</firstName><middleNames>S</middleNames><lastName>Birnbaum</lastName></author><author><firstName>Gerd</firstName><middleNames>R</middleNames><lastName>Burmester</lastName></author><author><firstName>Vivian</firstName><middleNames>P</middleNames><lastName>Bykerk</lastName></author><author><firstName>Marc</firstName><middleNames>D</middleNames><lastName>Cohen</lastName></author><author><firstName>Bernard</firstName><lastName>Combe</lastName></author><author><firstName>Karen</firstName><middleNames>H</middleNames><lastName>Costenbader</lastName></author><author><firstName>Maxime</firstName><lastName>Dougados</lastName></author><author><firstName>Paul</firstName><lastName>Emery</lastName></author><author><firstName>Gianfranco</firstName><lastName>Ferraccioli</lastName></author><author><firstName>Johanna</firstName><middleNames>M W</middleNames><lastName>Hazes</lastName></author><author><firstName>Kathryn</firstName><lastName>Hobbs</lastName></author><author><firstName>Tom</firstName><middleNames>W J</middleNames><lastName>Huizinga</lastName></author><author><firstName>Arthur</firstName><lastName>Kavanaugh</lastName></author><author><firstName>Jonathan</firstName><lastName>Kay</lastName></author><author><firstName>Tore</firstName><middleNames>K</middleNames><lastName>Kvien</lastName></author><author><firstName>Timothy</firstName><lastName>Laing</lastName></author><author><firstName>Philip</firstName><lastName>Mease</lastName></author><author><firstName>Henri</firstName><middleNames>A</middleNames><lastName>Ménard</lastName></author><author><firstName>Larry</firstName><middleNames>W</middleNames><lastName>Moreland</lastName></author><author><firstName>Raymond</firstName><middleNames>L</middleNames><lastName>Naden</lastName></author><author><firstName>Theodore</firstName><lastName>Pincus</lastName></author><author><firstName>Josef</firstName><middleNames>S</middleNames><lastName>Smolen</lastName></author><author><firstName>Ewa</firstName><lastName>Stanislawska-Biernat</lastName></author><author><firstName>Deborah</firstName><lastName>Symmons</lastName></author><author><firstName>Paul</firstName><middleNames>P</middleNames><lastName>Tak</lastName></author><author><firstName>Katherine</firstName><middleNames>S</middleNames><lastName>Upchurch</lastName></author><author><firstName>Ji?í</firstName><lastName>Vencovsk?</lastName></author><author><firstName>Frederick</firstName><lastName>Wolfe</lastName></author><author><firstName>Gillian</firstName><lastName>Hawker</lastName></author></authors></publication></publications><cites></cites></citation>(9) criteria;3) Report on anti-TNF used for the treatment of RA;4) Report on at least one measure of RA disease activity using DAS ADDIN PAPERS2_CITATIONS <citation><uuid>AF23C7E6-C542-4B69-98A9-10D86129CECD</uuid><priority>0</priority><publications><publication><uuid>6CDB8081-F142-4E91-A1EC-87E7BEAA1901</uuid><volume>49</volume><startpage>916</startpage><publication_date>99199011001200000000220000</publication_date><url> disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 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To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>Department of Rheumatology, University Hospital, Nijmegen, The Netherlands.</institution><number>11</number><subtype>400</subtype><endpage>920</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><lastName>Heijde</lastName><nonDroppingParticle>Van der</nonDroppingParticle><firstName>D</firstName><middleNames>M</middleNames></author><author><lastName>'t Hof</lastName><nonDroppingParticle>van</nonDroppingParticle><firstName>M</firstName><middleNames>A</middleNames></author><author><lastName>Riel</lastName><nonDroppingParticle>Van</nonDroppingParticle><firstName>P</firstName><middleNames>L</middleNames></author><author><firstName>L</firstName><middleNames>A</middleNames><lastName>Theunisse</lastName></author><author><firstName>E</firstName><middleNames>W</middleNames><lastName>Lubberts</lastName></author><author><lastName>Leeuwen</lastName><nonDroppingParticle>Van</nonDroppingParticle><firstName>M</firstName><middleNames>A</middleNames></author><author><lastName>Rijswijk</lastName><nonDroppingParticle>Van</nonDroppingParticle><firstName>M</firstName><middleNames>H</middleNames></author><author><lastName>Putte</lastName><nonDroppingParticle>Van de</nonDroppingParticle><firstName>L</firstName><middleNames>B</middleNames></author></authors></publication></publications><cites></cites></citation>(10), DAS28 ADDIN PAPERS2_CITATIONS <citation><uuid>BA9BB04F-FBAD-47CA-9C9D-F0CE4C09ECE6</uuid><priority>7</priority><publications><publication><uuid>F8AE1712-C459-401A-ABE6-B162AB2AC882</uuid><volume>38</volume><startpage>44</startpage><publication_date>99199408301200000000222000</publication_date><url> disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>Department of Rheumatology, University Hospital Nijmegen, The Netherlands.</institution><number>1</number><subtype>400</subtype><endpage>48</endpage><bundle><publication><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><title>Arthritis &amp; Rheumatism</title><type>-100</type><subtype>-100</subtype><uuid>017E4C24-9765-49C3-9586-D3B3425FB2F6</uuid></publication></bundle><authors><author><firstName>M</firstName><middleNames>L</middleNames><lastName>Prevoo</lastName></author><author><lastName>'t Hof</lastName><nonDroppingParticle>van</nonDroppingParticle><firstName>M</firstName><middleNames>A</middleNames></author><author><firstName>H</firstName><middleNames>H</middleNames><lastName>Kuper</lastName></author><author><lastName>Leeuwen</lastName><nonDroppingParticle>Van</nonDroppingParticle><firstName>M</firstName><middleNames>A</middleNames></author><author><lastName>Putte</lastName><nonDroppingParticle>Van de</nonDroppingParticle><firstName>L</firstName><middleNames>B</middleNames></author><author><lastName>Riel</lastName><nonDroppingParticle>Van</nonDroppingParticle><firstName>P</firstName><middleNames>L</middleNames></author></authors></publication><publication><publication_date>99200300001200000000200000</publication_date><title>Disease activity scores using C-reactive protein: CRP may replace ESR in the assessment of RA disease activity</title><uuid>6AE4558C-FECA-44B8-AB63-1EC44DB60091</uuid><subtype>420</subtype><publisher>Annals of the …</publisher><type>400</type><url> </title><type>-200</type><subtype>-200</subtype><uuid>FC935C76-B317-429D-9195-9420F64B0BF3</uuid></publication></bundle><authors><author><firstName>J</firstName><lastName>Fransen</lastName></author><author><firstName>PMJ</firstName><lastName>Welsing</lastName></author><author><nonDroppingParticle>De</nonDroppingParticle><firstName>RMH</firstName><lastName>Keijzer</lastName></author><author><lastName>Riel</lastName><nonDroppingParticle>Van</nonDroppingParticle><firstName>P</firstName><middleNames>C L M</middleNames></author></authors></publication></publications><cites></cites></citation>(11,12), CDAI ADDIN PAPERS2_CITATIONS <citation><uuid>B65FC122-A990-4874-9735-4B42D899C606</uuid><priority>0</priority><publications><publication><uuid>FA6BDA79-BA92-4C70-8176-9E9449A95CBA</uuid><volume>7</volume><accepted_date>99200503101200000000222000</accepted_date><doi>10.1186/ar1740</doi><startpage>R796</startpage><revision_date>99200502161200000000222000</revision_date><publication_date>99200500001200000000200000</publication_date><url> phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score.</title><publisher>BioMed Central Ltd</publisher><submission_date>99200412151200000000222000</submission_date><number>4</number><institution>Department of Rheumatology, Medical University of Vienna, Vienna, Austria. aletahad@mail.</institution><subtype>400</subtype><endpage>806</endpage><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><lastName>Aletaha</lastName></author><author><firstName>Valerie</firstName><middleNames>P K</middleNames><lastName>Nell</lastName></author><author><firstName>Tanja</firstName><lastName>Stamm</lastName></author><author><firstName>Martin</firstName><lastName>Uffmann</lastName></author><author><firstName>Stephan</firstName><lastName>Pflugbeil</lastName></author><author><firstName>Klaus</firstName><lastName>Machold</lastName></author><author><firstName>Josef</firstName><middleNames>S</middleNames><lastName>Smolen</lastName></author></authors></publication></publications><cites></cites></citation>(13), SDAI ADDIN PAPERS2_CITATIONS <citation><uuid>F551F1F0-BCF5-4E2E-ABB7-B2499DE4B577</uuid><priority>0</priority><publications><publication><uuid>76A64B7F-84EC-4A5B-8940-2C1A9E667643</uuid><volume>42</volume><doi>10.1093/rheumatology/keg072</doi><startpage>244</startpage><publication_date>99200302001200000000220000</publication_date><url> simplified disease activity index for rheumatoid arthritis for use in clinical practice.</title><institution>University of Vienna and Lainz Hospital, Austria. josef.smolen@wienkav.at</institution><number>2</number><subtype>400</subtype><endpage>257</endpage><bundle><publication><publisher>Oxford University Press</publisher><title>Rheumatology (Oxford, England)</title><type>-100</type><subtype>-100</subtype><uuid>38B8DB8B-2E23-49A3-81DD-FAD32CC17085</uuid></publication></bundle><authors><author><firstName>J</firstName><middleNames>S</middleNames><lastName>Smolen</lastName></author><author><firstName>F</firstName><middleNames>C</middleNames><lastName>Breedveld</lastName></author><author><firstName>M</firstName><middleNames>H</middleNames><lastName>Schiff</lastName></author><author><firstName>J</firstName><middleNames>R</middleNames><lastName>Kalden</lastName></author><author><firstName>P</firstName><lastName>Emery</lastName></author><author><firstName>G</firstName><lastName>Eberl</lastName></author><author><lastName>Riel</lastName><nonDroppingParticle>Van</nonDroppingParticle><firstName>P</firstName><middleNames>L</middleNames></author><author><firstName>P</firstName><lastName>Tugwell</lastName></author></authors></publication></publications><cites></cites></citation>(14), ACR/EULAR remission ADDIN PAPERS2_CITATIONS <citation><uuid>DFE4B35A-E346-4425-93C0-6ACD288F231A</uuid><priority>0</priority><publications><publication><volume>63</volume><publication_date>99201102031200000000222000</publication_date><number>3</number><doi>10.1002/art.30129</doi><startpage>573</startpage><title>American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials</title><uuid>57329603-16B9-49B2-864A-EE2B16618352</uuid><subtype>400</subtype><endpage>586</endpage><type>400</type><url> Subscription Services, Inc., A Wiley Company</publisher><title>Arthritis &amp; Rheumatism</title><type>-100</type><subtype>-100</subtype><uuid>017E4C24-9765-49C3-9586-D3B3425FB2F6</uuid></publication></bundle><authors><author><firstName>David</firstName><middleNames>T</middleNames><lastName>Felson</lastName></author><author><firstName>Josef</firstName><middleNames>S</middleNames><lastName>Smolen</lastName></author><author><firstName>George</firstName><lastName>Wells</lastName></author><author><firstName>Bin</firstName><lastName>Zhang</lastName></author><author><lastName>Tuyl</lastName><nonDroppingParticle>van</nonDroppingParticle><firstName>Lilian</firstName><middleNames>H D</middleNames></author><author><firstName>Julia</firstName><lastName>Funovits</lastName></author><author><firstName>Daniel</firstName><lastName>Aletaha</lastName></author><author><firstName>Cornelia</firstName><middleNames>F</middleNames><lastName>Allaart</lastName></author><author><firstName>Joan</firstName><lastName>Bathon</lastName></author><author><firstName>Stefano</firstName><lastName>Bombardieri</lastName></author><author><firstName>Peter</firstName><lastName>Brooks</lastName></author><author><firstName>Andrew</firstName><lastName>Brown</lastName></author><author><firstName>Marco</firstName><lastName>Matucci-Cerinic</lastName></author><author><firstName>Hyon</firstName><lastName>Choi</lastName></author><author><firstName>Bernard</firstName><lastName>Combe</lastName></author><author><nonDroppingParticle>de</nonDroppingParticle><firstName>Maarten</firstName><lastName>Wit</lastName></author><author><firstName>Maxime</firstName><lastName>Dougados</lastName></author><author><firstName>Paul</firstName><lastName>Emery</lastName></author><author><firstName>Daniel</firstName><lastName>Furst</lastName></author><author><firstName>Juan</firstName><lastName>Gomez-Reino</lastName></author><author><firstName>Gillian</firstName><lastName>Hawker</lastName></author><author><firstName>Edward</firstName><lastName>Keystone</lastName></author><author><firstName>Dinesh</firstName><lastName>Khanna</lastName></author><author><firstName>John</firstName><lastName>Kirwan</lastName></author><author><firstName>Tore</firstName><middleNames>K</middleNames><lastName>Kvien</lastName></author><author><firstName>Robert</firstName><lastName>Landewé</lastName></author><author><firstName>Joachim</firstName><lastName>Listing</lastName></author><author><firstName>Kaleb</firstName><lastName>Michaud</lastName></author><author><firstName>Emilio</firstName><lastName>Martin-Mola</lastName></author><author><firstName>Pamela</firstName><lastName>Montie</lastName></author><author><firstName>Theodore</firstName><lastName>Pincus</lastName></author><author><firstName>Pamela</firstName><lastName>Richards</lastName></author><author><firstName>Jeffrey</firstName><middleNames>N</middleNames><lastName>Siegel</lastName></author><author><firstName>Lee</firstName><middleNames>S</middleNames><lastName>Simon</lastName></author><author><firstName>Tuulikki</firstName><lastName>Sokka</lastName></author><author><firstName>Vibeke</firstName><lastName>Strand</lastName></author><author><firstName>Peter</firstName><lastName>Tugwell</lastName></author><author><firstName>Alan</firstName><lastName>Tyndall</lastName></author><author><nonDroppingParticle>van der</nonDroppingParticle><firstName>Desirée</firstName><lastName>Heijde</lastName></author><author><firstName>Suzan</firstName><lastName>Verstappen</lastName></author><author><firstName>Barbara</firstName><lastName>White</lastName></author><author><firstName>Frederick</firstName><lastName>Wolfe</lastName></author><author><firstName>Angela</firstName><lastName>Zink</lastName></author><author><firstName>Maarten</firstName><lastName>Boers</lastName></author></authors></publication></publications><cites></cites></citation>(15) or ARA 1981 remission criteria ADDIN PAPERS2_CITATIONS <citation><uuid>6181EBE4-9943-43C9-9994-5424070BC649</uuid><priority>0</priority><publications><publication><volume>24</volume><publication_date>99198100001200000000200000</publication_date><number>10</number><startpage>1308</startpage><title>Preliminary criteria for clinical remission in rheumatoid arthritis</title><uuid>2F8C5E18-D427-4B3A-9DDC-2AF2820F0DA5</uuid><subtype>400</subtype><publisher>Wiley Online Library</publisher><type>400</type><endpage>1315</endpage><url> Subscription Services, Inc., A Wiley Company</publisher><title>Arthritis &amp; Rheumatism</title><type>-100</type><subtype>-100</subtype><uuid>017E4C24-9765-49C3-9586-D3B3425FB2F6</uuid></publication></bundle><authors><author><firstName>Robert</firstName><middleNames>S</middleNames><lastName>Pinals</lastName></author><author><firstName>Alfonse</firstName><middleNames>T</middleNames><lastName>Masi</lastName></author><author><firstName>Richard</firstName><middleNames>A</middleNames><lastName>Larsen</lastName></author></authors></publication></publications><cites></cites></citation>(16);5) Report on predictors of sustained remission (at least six months) ADDIN PAPERS2_CITATIONS <citation><uuid>25BC55AB-9652-4DFC-AA14-7B6DDFF5F265</uuid><priority>0</priority><publications><publication><startpage>1</startpage><title>The OMERACT Handbook</title><uuid>485C07D3-DC1C-4BBB-AB57-769070F00BDE</uuid><subtype>713</subtype><endpage>124</endpage><type>700</type><publication_date>99201505191200000000222000</publication_date><authors><author><firstName>M</firstName><lastName>Boers</lastName></author><author><firstName>J</firstName><middleNames>R</middleNames><lastName>Kirwan</lastName></author><author><firstName>P</firstName><lastName>Tugwell</lastName></author></authors></publication></publications><cites></cites></citation>(4). Exclusion criteriaStudies where it was not possible to isolate the required data on patients in sustained remission, case-control, cross-sectional studies, case reports/series, phase one and two/laboratory studies, qualitative studies, survey-based studies, narrative reviews, conference abstracts and editorials were excluded.Search methods for identification of studies ?EMBASE, Medline and the Cochrane Controlled Trials Register were searched using the Ovid platform to 4th September 2015. The full search strategy for Medline is provided in supplementary online table 1. No language restriction was applied to search results. Reference lists of included studies were searched for additional citations and all authors were contacted for additional information to assist with the review and meta-analysis. Additional data were kindly provided by Dr Barnabe, Dr Einarsson, Dr Balogh, and Professor Tanaka.Assessment of studies for inclusion in the reviewAll search results were dual screened with dual data extraction and quality scoring using a custom Access? database. The quality of studies was assessed using the Newcastle-Ottawa Scale ADDIN PAPERS2_CITATIONS <citation><uuid>A2684F15-0D47-4C54-B807-62EFAB8AB65B</uuid><priority>13</priority><publications><publication><publication_date>99200800001200000000200000</publication_date><accepted_date>99201411191200000000222000</accepted_date><title>The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses</title><uuid>D9215C08-1CEB-46ED-A3F3-C3E9CA6043B1</uuid><subtype>403</subtype><type>400</type><url>'Connell</lastName></author><author><firstName>J</firstName><lastName>Peterson</lastName></author><author><firstName>V</firstName><lastName>Welch</lastName></author></authors></publication></publications><cites></cites></citation>(17). A narrative review of studies with relevant quantitative data extraction was undertaken. Corresponding authors were contacted to obtain unadjusted data to enable meta-analysis where appropriate. Sources of heterogeneity were investigated through structured critical appraisal. Meta-AnalysisStatistical analysis was undertaken using Review Manager Software version 5.3 ADDIN PAPERS2_CITATIONS <citation><uuid>A1478666-649C-4D18-882A-B8FF002893E8</uuid><priority>0</priority><publications><publication><type>300</type><publication_date>99201400001200000000200000</publication_date><title>Review Manager (RevMan)[Computer Program] Version 5.2. 3. Copenhagen: The Nordic Cochrane Centre; 2012</title><url>;(18). Because the factors incorporated in calculating adjusted odds ratios (OR) were not consistent between studies, unadjusted OR were used in meta-analysis where data were available from at least three studies. A random effects model was used to allow for between study variation. Heterogeneity between studies was assessed using I2 ADDIN PAPERS2_CITATIONS <citation><uuid>55530CF6-DBE3-4D7A-83EE-E663E9E50539</uuid><priority>0</priority><publications><publication><publication_date>99200800001200000000200000</publication_date><doi>10.1002/9780470712184.ch9</doi><title>Cochrane handbook for systematic reviews of interventions</title><uuid>A884A95B-28A6-490F-8E21-55936D4D9BA4</uuid><subtype>1</subtype><type>0</type><url>;(19) and publication bias was assessed using funnel plots.ResultsStudy identification4438 papers were identified from the search strategy. 4220 records were excluded and 218 full text papers, including 50 randomised controlled trials, were assessed. Six papers met the inclusion criteria and were included in the review ADDIN PAPERS2_CITATIONS <citation><uuid>9F48C005-A5AA-4830-8269-98FF8D2CDB65</uuid><priority>0</priority><publications><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication><publication><uuid>97F18509-75B5-4970-85F3-6E41256E9AEF</uuid><volume>76</volume><accepted_date>99200811141200000000222000</accepted_date><doi>10.1016/j.jbspin.2008.11.009</doi><startpage>350</startpage><publication_date>99200907001200000000220000</publication_date><url> of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis.</title><institution>Service de Rhumatologie, H?pital L'Archet 1, 06200 CHU Nice, Université Nice, Sophia Antipolis, France. obrocq@chpg.mc</institution><number>4</number><subtype>400</subtype><endpage>355</endpage><authors><author><firstName>Olivier</firstName><lastName>Brocq</lastName></author><author><firstName>Elodie</firstName><lastName>Millasseau</lastName></author><author><firstName>Christine</firstName><lastName>Albert</lastName></author><author><firstName>Christian</firstName><lastName>Grisot</lastName></author><author><firstName>Philippe</firstName><lastName>Flory</lastName></author><author><firstName>Christian-Hubert</firstName><lastName>Roux</lastName></author><author><firstName>Liana</firstName><lastName>Euller-Ziegler</lastName></author></authors></publication><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication></publications><cites></cites></citation>(20-25). One of these papers ADDIN PAPERS2_CITATIONS <citation><uuid>6B45B2CD-2CCC-4B60-8A4A-794F10D19BC4</uuid><priority>0</priority><publications><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication></publications><cites></cites></citation>(24) had included one patient aged less than 18 years old in one subgroup (personal correspondence), however, the mean age of all the subgroups and the overall cohort was in line with the other included papers, and it was decided to include the study in the review. The screening process is summarised in REF _Ref437955597 \h \* MERGEFORMAT Figure 1. Study designThe characteristics of the included studies (and quality assessed using Newcastle-Ottawa scores) are summarised in Tables 1 and 2. Two of the included studies were multicentre studies ADDIN PAPERS2_CITATIONS <citation><uuid>5C60A3CD-C390-4274-8858-ADA599BCB5F1</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication></publications><cites></cites></citation>(23,24), coordinated from one hospital, one of which was an open label, non-randomised trial ADDIN PAPERS2_CITATIONS <citation><uuid>BB20C66F-26A4-4374-9DA0-D5D69BEA96CE</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(23). One study was a retrospective case note review ADDIN PAPERS2_CITATIONS <citation><uuid>12B95264-9072-4E8A-9292-1EF990081B77</uuid><priority>0</priority><publications><publication><uuid>A5D1C957-9922-4CFD-A41C-ADEF9FAA10B0</uuid><volume>76</volume><doi>10.1016/j.jbspin.2008.11.009</doi><startpage>350</startpage><publication_date>99200907011200000000222000</publication_date><url> of discontinuing TNF&amp;alpha; antagonist therapy in patients with remission of rheumatoid arthritis</title><publisher>Elsevier Masson SAS</publisher><number>4</number><subtype>400</subtype><endpage>355</endpage><bundle><publication><publisher>Elsevier Masson SAS</publisher><title>Joint, bone, spine : revue du rhumatisme</title><type>-100</type><subtype>-100</subtype><uuid>4712090A-3038-4743-AF7B-0E0FD41D4A13</uuid></publication></bundle><authors><author><firstName>Olivier</firstName><lastName>Brocq</lastName></author><author><firstName>Elodie</firstName><lastName>Millasseau</lastName></author><author><firstName>Christine</firstName><lastName>Albert</lastName></author><author><firstName>Christian</firstName><lastName>Grisot</lastName></author><author><firstName>Philippe</firstName><lastName>Flory</lastName></author><author><firstName>Christian-Hubert</firstName><lastName>Roux</lastName></author><author><firstName>Liana</firstName><lastName>Euller-Ziegler</lastName></author></authors></publication></publications><cites></cites></citation>(26) and three were registry studies ADDIN PAPERS2_CITATIONS <citation><uuid>15CA361A-CBBA-44BE-BC20-11647383BF56</uuid><priority>0</priority><publications><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(20,21,25).Sources of HeterogeneityAll studies included in this review were observational by design and therefore there was variation in the range of treatments and patients included. Neither of the two multicentre studies ADDIN PAPERS2_CITATIONS <citation><uuid>B2D9F559-1229-4424-8065-9AAB1AC6FCB3</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication></publications><cites></cites></citation>(23,24), or the retrospective case note review ADDIN PAPERS2_CITATIONS <citation><uuid>6C438F66-C21A-4D74-B1B7-F4EDAD9D87ED</uuid><priority>0</priority><publications><publication><uuid>A5D1C957-9922-4CFD-A41C-ADEF9FAA10B0</uuid><volume>76</volume><doi>10.1016/j.jbspin.2008.11.009</doi><startpage>350</startpage><publication_date>99200907011200000000222000</publication_date><url> of discontinuing TNF&amp;alpha; antagonist therapy in patients with remission of rheumatoid arthritis</title><publisher>Elsevier Masson SAS</publisher><number>4</number><subtype>400</subtype><endpage>355</endpage><bundle><publication><publisher>Elsevier Masson SAS</publisher><title>Joint, bone, spine : revue du rhumatisme</title><type>-100</type><subtype>-100</subtype><uuid>4712090A-3038-4743-AF7B-0E0FD41D4A13</uuid></publication></bundle><authors><author><firstName>Olivier</firstName><lastName>Brocq</lastName></author><author><firstName>Elodie</firstName><lastName>Millasseau</lastName></author><author><firstName>Christine</firstName><lastName>Albert</lastName></author><author><firstName>Christian</firstName><lastName>Grisot</lastName></author><author><firstName>Philippe</firstName><lastName>Flory</lastName></author><author><firstName>Christian-Hubert</firstName><lastName>Roux</lastName></author><author><firstName>Liana</firstName><lastName>Euller-Ziegler</lastName></author></authors></publication></publications><cites></cites></citation>(26) described their selection criteria and therefore there is a potential for the introduction of bias. Three of the included papers were registry studies ADDIN PAPERS2_CITATIONS <citation><uuid>6D9D9F17-63CE-4D1C-B924-3B6792904F85</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20,21,25) and are more likely to be representative of the general RA population treated with anti-TNF. Definitions of sustained remission utilisedThe definitions of sustained remission varied across the included studies. The minimum length of time that different studies defined sustained remission, varied from at least six months, to nine months, or ‘two consecutive visits’ (verified to be at least six months ADDIN PAPERS2_CITATIONS <citation><uuid>143AA8DF-A6C0-4185-858E-C2586FC0A88F</uuid><priority>0</priority><publications><publication><uuid>6D48079B-259E-4147-9ADC-DF36566CFB5E</uuid><volume>43</volume><doi>10.1016/j.semarthrit.2013.02.002</doi><startpage>137</startpage><publication_date>99201310011200000000222000</publication_date><url> and persistence of new-onset clinical remission in rheumatoid arthritis patients</title><publisher>Elsevier</publisher><number>2</number><subtype>400</subtype><endpage>143</endpage><bundle><publication><publisher>Elsevier</publisher><title>Seminars in Arthritis and Rheumatism</title><type>-100</type><subtype>-100</subtype><uuid>F8FEB050-2F47-49CB-A715-B65B7E7D1EAF</uuid></publication></bundle><authors><author><firstName>Iris</firstName><lastName>Navarro-Millan</lastName></author><author><firstName>Lang</firstName><lastName>Chen</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author><author><firstName>Dimitrios</firstName><middleNames>A</middleNames><lastName>Pappas</lastName></author><author><firstName>Jeffrey</firstName><middleNames>R</middleNames><lastName>Curtis</lastName></author></authors></publication></publications><cites></cites></citation>(27)); and a range of outcome measures (DAS28, CDAI, SDAI, ACR/EULAR criteria) were also used. Additionally, Einarsson et. al. ADDIN PAPERS2_CITATIONS <citation><uuid>ACF40E2F-AF8C-4833-9D9B-7FA8A73A514F</uuid><priority>0</priority><publications><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication></publications><cites></cites></citation>(25) did not exclude patients who were in a state of sustained remission who had a single episode of increased disease activity. However, it was less clear how the other studies handled these cases. Missing dataThe extent of missing patient data in sustained remission was not clear in the study by Balogh et al. ADDIN PAPERS2_CITATIONS <citation><uuid>0C49CE70-FED0-433A-AC12-EBB29499C4FF</uuid><priority>0</priority><publications><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication></publications><cites></cites></citation>(24); and detail on 25% (seven patients) of the cohort in sustained remission was missing from the study by Brocq et al. ADDIN PAPERS2_CITATIONS <citation><uuid>942092AF-7619-4296-89A9-382D07951041</uuid><priority>0</priority><publications><publication><uuid>97F18509-75B5-4970-85F3-6E41256E9AEF</uuid><volume>76</volume><accepted_date>99200811141200000000222000</accepted_date><doi>10.1016/j.jbspin.2008.11.009</doi><startpage>350</startpage><publication_date>99200907001200000000220000</publication_date><url> of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis.</title><institution>Service de Rhumatologie, H?pital L'Archet 1, 06200 CHU Nice, Université Nice, Sophia Antipolis, France. obrocq@chpg.mc</institution><number>4</number><subtype>400</subtype><endpage>355</endpage><authors><author><firstName>Olivier</firstName><lastName>Brocq</lastName></author><author><firstName>Elodie</firstName><lastName>Millasseau</lastName></author><author><firstName>Christine</firstName><lastName>Albert</lastName></author><author><firstName>Christian</firstName><lastName>Grisot</lastName></author><author><firstName>Philippe</firstName><lastName>Flory</lastName></author><author><firstName>Christian-Hubert</firstName><lastName>Roux</lastName></author><author><firstName>Liana</firstName><lastName>Euller-Ziegler</lastName></author></authors></publication></publications><cites></cites></citation>(22) which meant that data from these studies could not be included in meta-analysis. A total of 46 patients (1.9%) were lost to follow-up in the study undertaken by Einarsson et. al. ADDIN PAPERS2_CITATIONS <citation><uuid>934358B5-0D03-457B-93C0-4F5B6FD32A81</uuid><priority>0</priority><publications><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication></publications><cites></cites></citation>(25), and last observation carried forward and LUNDEX correction was used to account for incomplete follow-up visits ADDIN PAPERS2_CITATIONS <citation><uuid>B174EFE7-EE6C-4E6C-AA78-54829DB76F4B</uuid><priority>0</priority><publications><publication><volume>54</volume><publication_date>99200600001200000000200000</publication_date><number>2</number><doi>10.1002/art.21570</doi><startpage>600</startpage><title>The LUNDEX, a new index of drug efficacy in clinical practice: Results of a five-year observational study of treatment with infliximab and etanercept among rheumatoid arthritis patients in southern Sweden</title><uuid>A7A5ADA0-B181-4A5E-B4DB-A5678B045B1B</uuid><subtype>400</subtype><endpage>606</endpage><type>400</type><url> Rheum.</title><type>-100</type><subtype>-100</subtype><uuid>1783B05B-2142-4262-874F-B3F55A813303</uuid></publication></bundle><authors><author><firstName>Lars</firstName><middleNames>Erik</middleNames><lastName>Kristensen</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author></authors></publication></publications><cites></cites></citation>(28). Barnabe et al ADDIN PAPERS2_CITATIONS <citation><uuid>38FAC6E7-E39D-4E0F-91FA-80F5BE7DD08F</uuid><priority>0</priority><publications><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20) and Furst et. al. ADDIN PAPERS2_CITATIONS <citation><uuid>63CAE144-B2B7-4161-A68D-D492516A78C4</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(21) did not use imputation, but did not give any information on missing data. Last observation carried forward was used to impute missing data in the HONOR Study ADDIN PAPERS2_CITATIONS <citation><uuid>0960372E-5F1A-4226-8A5E-63B55020A41F</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(23).Achievement of sustained remissionThere was wide variation in rates of sustained remission. The highest rate of DAS28 sustained remission was in the HONOR study ADDIN PAPERS2_CITATIONS <citation><uuid>29F85032-EEE8-45AC-BA9D-C31BD414A221</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(23) (38.1%), and the lowest rate of DAS28 sustained remission was noted in the CORRONA population ADDIN PAPERS2_CITATIONS <citation><uuid>BC7647D9-212A-4616-ACDA-30A2A5730051</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(21) (7.9%). Anti-TNFs and concomitant medications studiedThe studies identified in this systematic review include a range of anti-TNF medications. Some studies ADDIN PAPERS2_CITATIONS <citation><uuid>73E6431A-9803-4995-BD9B-FAF00DCB4620</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication><publication><uuid>97F18509-75B5-4970-85F3-6E41256E9AEF</uuid><volume>76</volume><accepted_date>99200811141200000000222000</accepted_date><doi>10.1016/j.jbspin.2008.11.009</doi><startpage>350</startpage><publication_date>99200907001200000000220000</publication_date><url> of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis.</title><institution>Service de Rhumatologie, H?pital L'Archet 1, 06200 CHU Nice, Université Nice, Sophia Antipolis, France. obrocq@chpg.mc</institution><number>4</number><subtype>400</subtype><endpage>355</endpage><authors><author><firstName>Olivier</firstName><lastName>Brocq</lastName></author><author><firstName>Elodie</firstName><lastName>Millasseau</lastName></author><author><firstName>Christine</firstName><lastName>Albert</lastName></author><author><firstName>Christian</firstName><lastName>Grisot</lastName></author><author><firstName>Philippe</firstName><lastName>Flory</lastName></author><author><firstName>Christian-Hubert</firstName><lastName>Roux</lastName></author><author><firstName>Liana</firstName><lastName>Euller-Ziegler</lastName></author></authors></publication><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20,22,23,25) specifically reported which anti-TNFs were studied, whereas the studies by Furst et al. ADDIN PAPERS2_CITATIONS <citation><uuid>4E42D89F-30D6-4263-B012-C8F624C9B348</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(21) and Balogh et al. ADDIN PAPERS2_CITATIONS <citation><uuid>730B36F2-CCC4-4380-A133-F3C3AD5126BC</uuid><priority>0</priority><publications><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication></publications><cites></cites></citation>(24) did not. Very little data was available for patients using the newer anti-TNF medications (certolizumab pegol and golimumab), and no data were available for biosimilar anti-TNF medications. Additionally, the use of concomitant allowable drug use (such as prednisolone and NSAIDs) differed between included studies (Table 2).Despite these differences, there were many similarities in the baseline demographics, including mean age, gender, and concomitant synthetic disease modifying anti rheumatic drug (DMARD) use (Table 2) suggesting that although there is likely to be heterogeneity between studies, there are sufficient similarities to allow comparison between studies.Impact of patient demographics on sustained remission Gender. Female gender was negatively associated with DAS28 sustained remission in two of the studies ADDIN PAPERS2_CITATIONS <citation><uuid>0CBACD2A-D3BC-4EDB-941E-DDE00FEB75EB</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication></publications><cites></cites></citation>(21,25) (Table 3). In contrast, Barnabe et al. did not find female gender to be significantly associated with sustained remission by DAS28, ACR/EULAR 2011, or SDAI criteria using multivariate modelling, although univariate analysis (personal communication; univariate analysis used in meta-analysis) did suggest an association. No association between sustained remission and gender was identified by Tanaka et al. ADDIN PAPERS2_CITATIONS <citation><uuid>E1586EE6-7B86-46EE-A510-3FEAD1D8F122</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(23), and was not reported by the remaining studies ADDIN PAPERS2_CITATIONS <citation><uuid>39A3C1CF-04CE-46E6-908F-88B4981BFE47</uuid><priority>0</priority><publications><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication><publication><uuid>97F18509-75B5-4970-85F3-6E41256E9AEF</uuid><volume>76</volume><accepted_date>99200811141200000000222000</accepted_date><doi>10.1016/j.jbspin.2008.11.009</doi><startpage>350</startpage><publication_date>99200907001200000000220000</publication_date><url> of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis.</title><institution>Service de Rhumatologie, H?pital L'Archet 1, 06200 CHU Nice, Université Nice, Sophia Antipolis, France. obrocq@chpg.mc</institution><number>4</number><subtype>400</subtype><endpage>355</endpage><authors><author><firstName>Olivier</firstName><lastName>Brocq</lastName></author><author><firstName>Elodie</firstName><lastName>Millasseau</lastName></author><author><firstName>Christine</firstName><lastName>Albert</lastName></author><author><firstName>Christian</firstName><lastName>Grisot</lastName></author><author><firstName>Philippe</firstName><lastName>Flory</lastName></author><author><firstName>Christian-Hubert</firstName><lastName>Roux</lastName></author><author><firstName>Liana</firstName><lastName>Euller-Ziegler</lastName></author></authors></publication></publications><cites></cites></citation>(22,24). Meta-analysis demonstrated a reduced likelihood of achieving sustained remission in females compared with males with low data heterogeneity and a low likelihood of publication bias ( REF _Ref444605217 \h \* MERGEFORMAT Figure 2).Age. Increasing age was negatively associated with sustained remission by DAS28 in three of the studies ADDIN PAPERS2_CITATIONS <citation><uuid>B403236B-E116-4C2F-917B-F818039FABD2</uuid><priority>0</priority><publications><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(21,24,25) but was not associated with sustained remission in the study by Tanaka et al. ADDIN PAPERS2_CITATIONS <citation><uuid>13B1A07A-0C9E-41C7-A419-462FCDE0F130</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(23) and was not reported by the remaining studies ADDIN PAPERS2_CITATIONS <citation><uuid>DCF43625-88BE-4088-8A8C-0AE677FBDB67</uuid><priority>0</priority><publications><publication><uuid>97F18509-75B5-4970-85F3-6E41256E9AEF</uuid><volume>76</volume><accepted_date>99200811141200000000222000</accepted_date><doi>10.1016/j.jbspin.2008.11.009</doi><startpage>350</startpage><publication_date>99200907001200000000220000</publication_date><url> of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis.</title><institution>Service de Rhumatologie, H?pital L'Archet 1, 06200 CHU Nice, Université Nice, Sophia Antipolis, France. obrocq@chpg.mc</institution><number>4</number><subtype>400</subtype><endpage>355</endpage><authors><author><firstName>Olivier</firstName><lastName>Brocq</lastName></author><author><firstName>Elodie</firstName><lastName>Millasseau</lastName></author><author><firstName>Christine</firstName><lastName>Albert</lastName></author><author><firstName>Christian</firstName><lastName>Grisot</lastName></author><author><firstName>Philippe</firstName><lastName>Flory</lastName></author><author><firstName>Christian-Hubert</firstName><lastName>Roux</lastName></author><author><firstName>Liana</firstName><lastName>Euller-Ziegler</lastName></author></authors></publication><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20,22). Uniform unadjusted data were not available for this variable to enable meta-analysis. Obesity. The only study to report the relationship between obesity and sustained remission identified a negative association according to ACR/EULAR Boolean criteria excluding the CRP, but not by the other remission criteria included in the study ADDIN PAPERS2_CITATIONS <citation><uuid>7A97A3FB-93FD-4FA3-9FAB-B3DEEBD12DE5</uuid><priority>0</priority><publications><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20). Impact of disease characteristics on sustained remissionBaseline disease activity. Higher baseline disease activity was associated with a reduced likelihood of achieving sustained remission using the DAS28 score ADDIN PAPERS2_CITATIONS <citation><uuid>E4A9B725-6F77-41D8-A1D8-7563590712E5</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(21,23,25) and CDAI ADDIN PAPERS2_CITATIONS <citation><uuid>E3D5EC24-6945-4F2F-8CA3-6065F87422D9</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(21). No association was noted between baseline disease activity and subsequent sustained remission in the multivariate analysis by Barnabe et al. ADDIN PAPERS2_CITATIONS <citation><uuid>A918E89C-C67A-41C6-94DD-521008852B97</uuid><priority>0</priority><publications><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20). The association between baseline disease activity and attainment of sustained remission was not reported in the remaining studies ADDIN PAPERS2_CITATIONS <citation><uuid>B16AF3F2-8B3E-46B1-9BE7-5A6D137F13C8</uuid><priority>0</priority><publications><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication><publication><uuid>97F18509-75B5-4970-85F3-6E41256E9AEF</uuid><volume>76</volume><accepted_date>99200811141200000000222000</accepted_date><doi>10.1016/j.jbspin.2008.11.009</doi><startpage>350</startpage><publication_date>99200907001200000000220000</publication_date><url> of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis.</title><institution>Service de Rhumatologie, H?pital L'Archet 1, 06200 CHU Nice, Université Nice, Sophia Antipolis, France. obrocq@chpg.mc</institution><number>4</number><subtype>400</subtype><endpage>355</endpage><authors><author><firstName>Olivier</firstName><lastName>Brocq</lastName></author><author><firstName>Elodie</firstName><lastName>Millasseau</lastName></author><author><firstName>Christine</firstName><lastName>Albert</lastName></author><author><firstName>Christian</firstName><lastName>Grisot</lastName></author><author><firstName>Philippe</firstName><lastName>Flory</lastName></author><author><firstName>Christian-Hubert</firstName><lastName>Roux</lastName></author><author><firstName>Liana</firstName><lastName>Euller-Ziegler</lastName></author></authors></publication></publications><cites></cites></citation>(22,24). Patient Global Score. A lower baseline patient global score was associated with sustained remission in the HONOR study ADDIN PAPERS2_CITATIONS <citation><uuid>95E69DF3-63DB-4319-A407-A8248100B3C6</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(23). However, the only other study to include patient global scores did not identify any association ADDIN PAPERS2_CITATIONS <citation><uuid>E328E171-EFBF-4D3C-B31F-97F3C964CC9B</uuid><priority>0</priority><publications><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20). Acute phase reactants. An elevated erythrocyte sedimentation rate (ESR) was negatively associated with sustained remission in the HONOR study ADDIN PAPERS2_CITATIONS <citation><uuid>DB4B5A9F-6A2B-4003-83E3-6CDAEB41C19E</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(23), but not in the study by Barnabe et al. ADDIN PAPERS2_CITATIONS <citation><uuid>790B6E64-171E-4654-8D03-5C30E6A0655E</uuid><priority>0</priority><publications><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20). The C-reactive protein (CRP) did not predict sustained remission in the two studies where it was reported ADDIN PAPERS2_CITATIONS <citation><uuid>D24E5294-1D2F-4E70-90D6-D5AF1879C231</uuid><priority>0</priority><publications><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20,25).Number of tender and swollen joints. A greater number of tender joints negatively predicted sustained remission by CDAI criteria ADDIN PAPERS2_CITATIONS <citation><uuid>C2FAA2CE-5686-4792-9CDB-4448DABCD904</uuid><priority>0</priority><publications><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20) and DAS28 criteria ADDIN PAPERS2_CITATIONS <citation><uuid>5EC0D473-E5AD-4D10-BE0F-004473A916FC</uuid><priority>0</priority><publications><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication></publications><cites></cites></citation>(24). However, no association was identified by Tanaka et al. ADDIN PAPERS2_CITATIONS <citation><uuid>E28B7AC3-EC2A-4715-B1C5-34B947094B75</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(23). A higher swollen joint count was not identified as being associated with sustained remission in any of the four studies that reported this data ADDIN PAPERS2_CITATIONS <citation><uuid>4DDE2910-7ED9-45EF-820A-CBE456655E01</uuid><priority>0</priority><publications><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20,21,23,24).Functional impairment. Higher rates of patient-reported functional impairment at baseline (assessed using the Stanford Health Assessment Questionnaire; HAQ) were consistently associated with lower rates of sustained remission ADDIN PAPERS2_CITATIONS <citation><uuid>CACF66A3-B30B-4C81-A657-C711E0F9ECF7</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication></publications><cites></cites></citation>(21,23,25). Only one study did not identify an association between baseline HAQ score and sustained remission on multivariate analysis ADDIN PAPERS2_CITATIONS <citation><uuid>92D142B2-6ACD-44DC-98D3-35D91062B657</uuid><priority>0</priority><publications><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20). The effect of baseline functional impairment on remission status was not reported in the remaining studies ADDIN PAPERS2_CITATIONS <citation><uuid>87622B08-C176-4536-A765-532D71D3983D</uuid><priority>0</priority><publications><publication><uuid>A5D1C957-9922-4CFD-A41C-ADEF9FAA10B0</uuid><volume>76</volume><doi>10.1016/j.jbspin.2008.11.009</doi><startpage>350</startpage><publication_date>99200907011200000000222000</publication_date><url> of discontinuing TNF&amp;alpha; antagonist therapy in patients with remission of rheumatoid arthritis</title><publisher>Elsevier Masson SAS</publisher><number>4</number><subtype>400</subtype><endpage>355</endpage><bundle><publication><publisher>Elsevier Masson SAS</publisher><title>Joint, bone, spine : revue du rhumatisme</title><type>-100</type><subtype>-100</subtype><uuid>4712090A-3038-4743-AF7B-0E0FD41D4A13</uuid></publication></bundle><authors><author><firstName>Olivier</firstName><lastName>Brocq</lastName></author><author><firstName>Elodie</firstName><lastName>Millasseau</lastName></author><author><firstName>Christine</firstName><lastName>Albert</lastName></author><author><firstName>Christian</firstName><lastName>Grisot</lastName></author><author><firstName>Philippe</firstName><lastName>Flory</lastName></author><author><firstName>Christian-Hubert</firstName><lastName>Roux</lastName></author><author><firstName>Liana</firstName><lastName>Euller-Ziegler</lastName></author></authors></publication><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication></publications><cites></cites></citation>(24,26).Disease duration. One study identified that increased disease duration (stratified into five-yearly increments) was associated with a decreased likelihood of achieving sustained remission with the CDAI but not DAS28 criteria ADDIN PAPERS2_CITATIONS <citation><uuid>4100EB81-0ECB-4544-918F-54A042F5C383</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(21). Shorter disease duration was associated with an increased likelihood of achieving sustained DAS28 remission in one study ADDIN PAPERS2_CITATIONS <citation><uuid>DC01B40C-9D29-4CD5-8F17-509EC712FC41</uuid><priority>42</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(23). The remaining studies either found no association ADDIN PAPERS2_CITATIONS <citation><uuid>445F20E5-E7B3-44ED-9CF7-3C1F10DF382F</uuid><priority>0</priority><publications><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20,25) or did not report on the association between disease duration and sustained remission ADDIN PAPERS2_CITATIONS <citation><uuid>56220335-259A-41CD-B2BB-2990572BAC16</uuid><priority>44</priority><publications><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication><publication><uuid>97F18509-75B5-4970-85F3-6E41256E9AEF</uuid><volume>76</volume><accepted_date>99200811141200000000222000</accepted_date><doi>10.1016/j.jbspin.2008.11.009</doi><startpage>350</startpage><publication_date>99200907001200000000220000</publication_date><url> of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis.</title><institution>Service de Rhumatologie, H?pital L'Archet 1, 06200 CHU Nice, Université Nice, Sophia Antipolis, France. obrocq@chpg.mc</institution><number>4</number><subtype>400</subtype><endpage>355</endpage><authors><author><firstName>Olivier</firstName><lastName>Brocq</lastName></author><author><firstName>Elodie</firstName><lastName>Millasseau</lastName></author><author><firstName>Christine</firstName><lastName>Albert</lastName></author><author><firstName>Christian</firstName><lastName>Grisot</lastName></author><author><firstName>Philippe</firstName><lastName>Flory</lastName></author><author><firstName>Christian-Hubert</firstName><lastName>Roux</lastName></author><author><firstName>Liana</firstName><lastName>Euller-Ziegler</lastName></author></authors></publication></publications><cites></cites></citation>(22,24). Early response to treatment. Response at 16 weeks after treatment was only reported by one study ADDIN PAPERS2_CITATIONS <citation><uuid>20017AC5-365C-44B9-97A7-34A255B9C576</uuid><priority>0</priority><publications><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20) and was associated with an increased likelihood of achieving of sustained remission by DAS28 criteria.Concurrent and Past Medication Use Methotrexate. Concomitant methotrexate use was positively associated with sustained remission by DAS28 criteria ADDIN PAPERS2_CITATIONS <citation><uuid>8692821C-BD6D-4604-854C-E6CA76FC5751</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication></publications><cites></cites></citation>(21,25) and CDAI ADDIN PAPERS2_CITATIONS <citation><uuid>2AD6118C-5A8C-40B7-898E-0249C42B51CA</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(21). However, Tanaka et al. ADDIN PAPERS2_CITATIONS <citation><uuid>8AC56298-EE2F-4389-A174-C22152321EEF</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(23) did not find any significant difference in baseline methotrexate dose between the sustained and non-sustained remission groups. Prednisolone. Prednisolone use was negatively associated with sustained CDAI but not sustained DAS28 remission in one study ADDIN PAPERS2_CITATIONS <citation><uuid>C9CB919B-4AC7-458B-91B0-88B54357633D</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(21). However, no association was identified in the study by Einarsson et. al. ADDIN PAPERS2_CITATIONS <citation><uuid>EEA0CCD0-4703-4A50-AD4A-9784A45146AD</uuid><priority>0</priority><publications><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication></publications><cites></cites></citation>(25). Prednisolone use was restricted to a stable dose of less than 5mg in one study ADDIN PAPERS2_CITATIONS <citation><uuid>0F129A9E-C16A-42A3-9032-769B2A3C2393</uuid><priority>0</priority><publications><publication><uuid>A5D1C957-9922-4CFD-A41C-ADEF9FAA10B0</uuid><volume>76</volume><doi>10.1016/j.jbspin.2008.11.009</doi><startpage>350</startpage><publication_date>99200907011200000000222000</publication_date><url> of discontinuing TNF&amp;alpha; antagonist therapy in patients with remission of rheumatoid arthritis</title><publisher>Elsevier Masson SAS</publisher><number>4</number><subtype>400</subtype><endpage>355</endpage><bundle><publication><publisher>Elsevier Masson SAS</publisher><title>Joint, bone, spine : revue du rhumatisme</title><type>-100</type><subtype>-100</subtype><uuid>4712090A-3038-4743-AF7B-0E0FD41D4A13</uuid></publication></bundle><authors><author><firstName>Olivier</firstName><lastName>Brocq</lastName></author><author><firstName>Elodie</firstName><lastName>Millasseau</lastName></author><author><firstName>Christine</firstName><lastName>Albert</lastName></author><author><firstName>Christian</firstName><lastName>Grisot</lastName></author><author><firstName>Philippe</firstName><lastName>Flory</lastName></author><author><firstName>Christian-Hubert</firstName><lastName>Roux</lastName></author><author><firstName>Liana</firstName><lastName>Euller-Ziegler</lastName></author></authors></publication></publications><cites></cites></citation>(26) and patients taking concomitant corticosteroids were excluded from two studies ADDIN PAPERS2_CITATIONS <citation><uuid>919CF542-3D31-4C73-B538-C3F25AEB4983</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication><publication><uuid>F32AEB04-E933-43F2-9668-5E0315B539F4</uuid><volume>41</volume><doi>10.3899/jrheum.131451</doi><startpage>1607</startpage><publication_date>99201408001200000000220000</publication_date><url> effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.</title><location>&lt;html&gt;&lt;head&gt;&lt;meta http-equiv="content-type" content="text/html; charset=utf-8"/&gt;&lt;title&gt;Sorry...&lt;/title&gt;&lt;style&gt; body { font-family: verdana, arial, sans-serif; background-color: #fff; color: #000; }&lt;/style&gt;&lt;/head&gt;&lt;body&gt;&lt;div&gt;&lt;table&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;&lt;font face=times color=#0039b6 size=10&gt;G&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#f3c518 size=10&gt;o&lt;/font&gt;&lt;font face=times color=#0039b6 size=10&gt;g&lt;/font&gt;&lt;font face=times color=#30a72f size=10&gt;l&lt;/font&gt;&lt;font face=times color=#c41200 size=10&gt;e&lt;/font&gt;&lt;/b&gt;&lt;/td&gt;&lt;td style="text-align: left; vertical-align: bottom; padding-bottom: 15px; width: 50%"&gt;&lt;div style="border-bottom: 1px solid #dfdfdf;"&gt;Sorry...&lt;/div&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;&lt;h1&gt;We're sorry...&lt;/h1&gt;&lt;p&gt;... but your computer or network may be sending automated queries. To protect our users, we can't process your request right now.&lt;/p&gt;&lt;/div&gt;&lt;div style="margin-left: 4em;"&gt;See &lt;a href=""&gt;Google Help&lt;/a&gt; for more information.&lt;br/&gt;&lt;br/&gt;&lt;/div&gt;&lt;div style="text-align: center; border-top: 1px solid #dfdfdf;"&gt;&amp;copy; 2013 Google - &lt;a href=""&gt;Google Home&lt;/a&gt;&lt;/div&gt;&lt;/body&gt;&lt;/html&gt;</location><institution>From the Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Calgary; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRPC, Assistant Professor, Department of Medicine, and the Department of Community Health Sciences, University of Calgary; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; S.G. Barr, MD, MSC, FRCPC, Associate Professor; L. Martin, MB, ChB, FRCPC, Professor, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Professor, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca.</institution><number>8</number><subtype>400</subtype><endpage>1613</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Cheryl</firstName><lastName>Barnabe</lastName></author><author><firstName>Joanne</firstName><lastName>Homik</lastName></author><author><firstName>Susan</firstName><middleNames>G</middleNames><lastName>Barr</lastName></author><author><firstName>Liam</firstName><lastName>Martin</lastName></author><author><firstName>Walter</firstName><middleNames>P</middleNames><lastName>Maksymowych</lastName></author></authors></publication></publications><cites></cites></citation>(20,23). The remaining study did not report corticosteroid use ADDIN PAPERS2_CITATIONS <citation><uuid>675FAF00-0CB6-45BA-910A-F38658523E7B</uuid><priority>0</priority><publications><publication><uuid>F393C0EC-DE73-45ED-92B4-D68355948354</uuid><volume>15</volume><accepted_date>99201312101200000000222000</accepted_date><doi>10.1186/ar4421</doi><startpage>R221</startpage><publication_date>99201300001200000000200000</publication_date><url> of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder.</title><publisher>BioMed Central Ltd</publisher><submission_date>99201306211200000000222000</submission_date><number>6</number><subtype>400</subtype><bundle><publication><publisher>Arthritis Research &amp; Therapy</publisher><title>Arthritis Res. Ther.</title><type>-100</type><subtype>-100</subtype><uuid>8CD112C0-423E-440D-B8BC-7D065CEBB597</uuid></publication></bundle><authors><author><firstName>Emese</firstName><lastName>Balogh</lastName></author><author><firstName>Joao</firstName><lastName>Madruga Dias</lastName></author><author><firstName>Carl</firstName><lastName>Orr</lastName></author><author><firstName>Ronan</firstName><lastName>Mullan</lastName></author><author><firstName>Len</firstName><lastName>Harty</lastName></author><author><firstName>Oliver</firstName><lastName>FitzGerald</lastName></author><author><firstName>Phil</firstName><lastName>Gallagher</lastName></author><author><firstName>Miriam</firstName><lastName>Molloy</lastName></author><author><firstName>Eileen</firstName><lastName>O'Flynn</lastName></author><author><firstName>Alexia</firstName><lastName>Kelly</lastName></author><author><firstName>Patricia</firstName><lastName>Minnock</lastName></author><author><firstName>Madeline</firstName><lastName>O'Neill</lastName></author><author><firstName>Louise</firstName><lastName>Moore</lastName></author><author><firstName>Mairead</firstName><lastName>Murray</lastName></author><author><firstName>Ursula</firstName><lastName>Fearon</lastName></author><author><firstName>Douglas</firstName><middleNames>J</middleNames><lastName>Veale</lastName></author></authors></publication></publications><cites></cites></citation>(24).Prior anti-TNF use and Efficacy. Furst et al. ADDIN PAPERS2_CITATIONS <citation><uuid>BB37B599-548C-4268-A006-4C267BB55C19</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(21) was the only study to report data on prior anti-TNF use and found that this was negatively associated with sustained remission in both DAS28 and CDAI measurements. Einarsson et al. ADDIN PAPERS2_CITATIONS <citation><uuid>A25B2839-5F0A-4A31-987F-878A4A867655</uuid><priority>0</priority><publications><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication></publications><cites></cites></citation>(25) investigated time to sustained remission for each anti-TNF and found that etanercept was associated with an increased likelihood of achieving sustained remission within the first twelve months on treatment when compared with infliximab.DiscussionDespite the variability in both the definition of sustained remission, and the predictive factors reported by each study, some common themes have emerged. One of the most striking findings was the paucity of evidence available for factors associated with sustained remission as an outcome. From over 4000 possible manuscripts identified in the search, only six studies were identified which met the inclusion criteria, all of which were observational. With the exception of one study ADDIN PAPERS2_CITATIONS <citation><uuid>F72C84AA-C3DA-4461-BC4B-27BB4A219938</uuid><priority>0</priority><publications><publication><uuid>C83AECC5-6F72-40A6-9621-2511AC0287AE</uuid><volume>74</volume><doi>10.1136/annrheumdis-2013-204016</doi><startpage>389</startpage><publication_date>99201502001200000000220000</publication_date><url> of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.</institution><number>2</number><subtype>400</subtype><endpage>395</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Yoshiya</firstName><lastName>Tanaka</lastName></author><author><firstName>Shintaro</firstName><lastName>Hirata</lastName></author><author><firstName>Satoshi</firstName><lastName>Kubo</lastName></author><author><firstName>Shunsuke</firstName><lastName>Fukuyo</lastName></author><author><firstName>Kentaro</firstName><lastName>Hanami</lastName></author><author><firstName>Norifumi</firstName><lastName>Sawamukai</lastName></author><author><firstName>Kazuhisa</firstName><lastName>Nakano</lastName></author><author><firstName>Shingo</firstName><lastName>Nakayamada</lastName></author><author><firstName>Kunihiro</firstName><lastName>Yamaoka</lastName></author><author><firstName>Fusae</firstName><lastName>Sawamura</lastName></author><author><firstName>Kazuyoshi</firstName><lastName>Saito</lastName></author></authors></publication></publications><cites></cites></citation>(23), only 4.5% - 15.8% of patients were identified as being in sustained remission in any of the studies. A number of clinical factors including increased disease duration, higher baseline disease activity score, increased baseline tender joint count, and a greater baseline functional impairment are associated with a reduced likelihood of achieving sustained remission. Demographic factors that appear to be negatively associated with sustained remission include female gender and increasing age. Only one clinical factor (methotrexate co-prescription) was associated with an increased likelihood of achieving sustained remission in more than one study. Supporting these findings, Katchamart et al. also identified these factors as predictors of point remission in a systematic review ADDIN PAPERS2_CITATIONS <citation><uuid>3C6C630E-59E4-4BAB-89A7-129E3B19CC59</uuid><priority>0</priority><publications><publication><uuid>31F84319-4E61-4116-951E-EA56799E4015</uuid><volume>62</volume><doi>10.1002/acr.20188</doi><startpage>1128</startpage><publication_date>99201003161200000000222000</publication_date><url> for remission in rheumatoid arthritis patients: A systematic review</title><number>8</number><subtype>400</subtype><endpage>1143</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Wanruchada</firstName><lastName>Katchamart</lastName></author><author><firstName>Sindhu</firstName><lastName>Johnson</lastName></author><author><firstName>Hsing-Ju</firstName><middleNames>Lucy</middleNames><lastName>Lin</lastName></author><author><firstName>Veerapong</firstName><lastName>Phumethum</lastName></author><author><firstName>Carine</firstName><lastName>Salliot</lastName></author><author><firstName>Claire</firstName><lastName>Bombardier</lastName></author></authors></publication></publications><cites></cites></citation>(5). Interestingly, the rates of sustained DAS28 remission identified in this review (7.9 – 38.1%) compare favourably with the range of point DAS28 remission rates (5 - 40%) identified by Katchamart et. al. However, the studies identified by Katchamart et.al. included both biologic and synthetic DMARD treated RA patients enrolled in studies between 1999 to 2008. By comparison, this review focused on anti-TNF treated patients only, and the oldest study in this review dates from 2009.Our review identified that female gender appears to be strongly associated with a reduced likelihood of achieving sustained remission in two of the included studies. However, female gender has been associated with a higher baseline ESR in a normal ‘healthy’ population compared with males, and is also known to increase with age ADDIN PAPERS2_CITATIONS <citation><uuid>249789BD-668C-4DA2-8DC9-A5B053AD0A52</uuid><priority>0</priority><publications><publication><volume>240</volume><publication_date>99199609001200000000220000</publication_date><number>3</number><institution>Institute of Pathology, University of Oslo, Norway.</institution><startpage>125</startpage><title>Population-based erythrocyte sedimentation rates in 3910 subjectively healthy Norwegian adults. A statistical study based on men and women from the Oslo area.</title><uuid>E0A44892-9FF8-473D-BFC3-715397D59A38</uuid><subtype>400</subtype><endpage>131</endpage><type>400</type><url> Publishing Ltd</publisher><title>Journal of internal medicine</title><type>-100</type><subtype>-100</subtype><uuid>6B231987-7A8C-488B-9BFC-0BB8D6A12C53</uuid></publication></bundle><authors><author><firstName>P</firstName><lastName>Wetteland</lastName></author><author><firstName>M</firstName><lastName>R?ger</lastName></author><author><firstName>H</firstName><middleNames>E</middleNames><lastName>Solberg</lastName></author><author><firstName>O</firstName><middleNames>H</middleNames><lastName>Iversen</lastName></author></authors></publication></publications><cites></cites></citation>(29). Given ESR is a component in the DAS28-ESR, it is possible that variations in gender and age may be confounders in the interpretation of the score which does not have different thresholds for these factors, rather than being true predictors of poor response. This may explain why Furst et al. ADDIN PAPERS2_CITATIONS <citation><uuid>EA3AD4A8-BF81-42E9-B3B6-618FDFEEAA78</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(21) identified that female gender was associated with a lower likelihood of achieving sustained remission when using DAS28-ESR criteria, but not when using CDAI (which does not include an inflammatory marker component).The finding that both increasing age and longer disease duration are both associated with a reduced likelihood of achieving sustained remission is unsurprising, and further studies are required to ascertain the independence of these effects. An important finding is the impact of baseline functional impairment on likelihood of achieving sustained remission. However, it remains uncertain whether worse functional impairment is a true predictor of response, or acting as a proxy marker of recalcitrant higher disease activity, irreversible joint damage, pain or fatigue, which may not be responsive to anti-TNF.The only intervention that was associated with an increased likelihood of achieving sustained remission was methotrexate co-prescription. Whilst there may be alternative causal pathways that are responsible for this association (e.g. confounding by indication arising from the differing tolerance of methotrexate between patients), and it is difficult to assess cause and effect pathways using solely observational data, this association does appear to support the practice of co-prescription of methotrexate with anti-TNF wherever possible ADDIN PAPERS2_CITATIONS <citation><uuid>6DD8AF43-C7A3-4D5A-BC4B-23D4F35C38D6</uuid><priority>0</priority><publications><publication><publication_date>99201000001200000000200000</publication_date><institution>West Midlands Health Technology Assessment Collaboration, University of Birmingham, Edgbaston, Birmingham, UK.</institution><title>Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a tumour necrosis factor inhibitor</title><uuid>6FECFDE0-6F1D-4B05-842D-C093B2C81001</uuid><subtype>400</subtype><type>400</type><citekey></citekey><url> Technol Assess</title><type>-100</type><subtype>-100</subtype><uuid>7764BEEA-0A27-4313-93C8-62A0776C9F07</uuid></publication></bundle></publication></publications><cites></cites></citation>(30). There was an absence of any comorbidity data in the included studies. Furst et. al. ADDIN PAPERS2_CITATIONS <citation><uuid>DDE39586-57D4-46C9-9093-9F322671772A</uuid><priority>0</priority><publications><publication><uuid>BE55B732-1356-4B97-8E45-02450BDD2F26</uuid><volume>63</volume><doi>10.1002/acr.20452</doi><startpage>856</startpage><publication_date>99201105311200000000222000</publication_date><url> likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry</title><number>6</number><subtype>400</subtype><endpage>864</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Daniel</firstName><middleNames>E</middleNames><lastName>Furst</lastName></author><author><firstName>Aileen</firstName><middleNames>L</middleNames><lastName>Pangan</lastName></author><author><firstName>Leslie</firstName><middleNames>R</middleNames><lastName>Harrold</lastName></author><author><firstName>Hong</firstName><lastName>Chang</lastName></author><author><firstName>George</firstName><lastName>Reed</lastName></author><author><firstName>Joel</firstName><middleNames>M</middleNames><lastName>Kremer</lastName></author><author><firstName>Jeffrey</firstName><middleNames>D</middleNames><lastName>Greenberg</lastName></author></authors></publication></publications><cites></cites></citation>(21) and Einarsson et al ADDIN PAPERS2_CITATIONS <citation><uuid>DADCA5BB-5DE8-4F35-B260-8A268BB18C0C</uuid><priority>0</priority><publications><publication><uuid>E18D0001-B1E5-4931-926A-17DD231827CB</uuid><volume>42</volume><accepted_date>99201501021200000000222000</accepted_date><doi>10.3899/jrheum.131502</doi><startpage>741</startpage><publication_date>99201505001200000000220000</publication_date><url> Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study.</title><publisher>The Journal of Rheumatology</publisher><institution>From the Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital, Lund, Sweden.J.T. Einarsson, MD; P. Geborek, MD, PhD; T. Saxne, MD, PhD; M.C. Kapetanovic, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Sk?ne University Hospital. jonthorkell@.</institution><number>5</number><subtype>400</subtype><endpage>748</endpage><bundle><publication><title>The Journal of Rheumatology</title><type>-100</type><subtype>-100</subtype><uuid>3490C300-550F-4AA1-A0DB-F4F4785FD1BA</uuid></publication></bundle><authors><author><firstName>Jon</firstName><middleNames>Thorkell</middleNames><lastName>Einarsson</lastName></author><author><firstName>Pierre</firstName><lastName>Geborek</lastName></author><author><firstName>Tore</firstName><lastName>Saxne</lastName></author><author><firstName>Meliha</firstName><middleNames>C</middleNames><lastName>Kapetanovic</lastName></author></authors></publication></publications><cites></cites></citation>(25) both describe collection of comorbidity data, however no analysis was reported. None of the other studies included any reporting on comorbidity data. The association between RA and increased cardiovascular risk is well documented ADDIN PAPERS2_CITATIONS <citation><uuid>ED7CCB57-9AC2-4BF9-8A78-8E2DCE80CA6F</uuid><priority>0</priority><publications><publication><uuid>D317BE55-87BA-4F0C-BB81-DA93CB1E907F</uuid><volume>71</volume><doi>10.1136/annrheumdis-2011-200726</doi><startpage>1524</startpage><publication_date>99201209001200000000220000</publication_date><url> of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies.</title><institution>Arthritis Research Centre of Canada, 895 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 1L7. azubieta@arthritisresearch.ca</institution><number>9</number><subtype>400</subtype><endpage>1529</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Juan</firstName><middleNames>Antonio</middleNames><lastName>Avina-Zubieta</lastName></author><author><firstName>Jamie</firstName><lastName>Thomas</lastName></author><author><firstName>Mohsen</firstName><lastName>Sadatsafavi</lastName></author><author><firstName>Allen</firstName><middleNames>J</middleNames><lastName>Lehman</lastName></author><author><firstName>Diane</firstName><lastName>Lacaille</lastName></author></authors></publication></publications><cites></cites></citation>(31), as is the apparent risk reduction in RA patients successfully treated with anti-TNF ADDIN PAPERS2_CITATIONS <citation><uuid>D0A88E57-DC9B-4BA5-A88B-30E31E0D7B94</uuid><priority>0</priority><publications><publication><uuid>E9F8A40B-B270-4E80-9D51-F84BA800BC8F</uuid><volume>74</volume><doi>10.1136/annrheumdis-2014-206624</doi><startpage>480</startpage><publication_date>99201503001200000000220000</publication_date><url> effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis.</title><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><institution>University of Montreal Hospital Research Center (CRCHUM), Notre-Dame Hospital, Montreal, Quebec, Canada.</institution><number>3</number><subtype>400</subtype><endpage>489</endpage><bundle><publication><title>Annals of the Rheumatic Diseases</title><type>-100</type><subtype>-100</subtype><uuid>35E06A75-3E86-400B-8DE8-F137EB8A6791</uuid></publication></bundle><authors><author><firstName>Camille</firstName><lastName>Roubille</lastName></author><author><firstName>Vincent</firstName><lastName>Richer</lastName></author><author><firstName>Tara</firstName><lastName>Starnino</lastName></author><author><firstName>Collette</firstName><lastName>McCourt</lastName></author><author><firstName>Alexandra</firstName><lastName>McFarlane</lastName></author><author><firstName>Patrick</firstName><lastName>Fleming</lastName></author><author><firstName>Stephanie</firstName><lastName>Siu</lastName></author><author><firstName>John</firstName><lastName>Kraft</lastName></author><author><firstName>Charles</firstName><lastName>Lynde</lastName></author><author><firstName>Janet</firstName><lastName>Pope</lastName></author><author><firstName>Wayne</firstName><lastName>Gulliver</lastName></author><author><firstName>Stephanie</firstName><lastName>Keeling</lastName></author><author><firstName>Jan</firstName><lastName>Dutz</lastName></author><author><firstName>Louis</firstName><lastName>Bessette</lastName></author><author><firstName>Robert</firstName><lastName>Bissonnette</lastName></author><author><firstName>Boulos</firstName><lastName>Haraoui</lastName></author></authors></publication></publications><cites></cites></citation>(32). However, this review did not identify any evidence on cardiovascular outcomes in RA patients achieving sustained remission with anti-TNF.Interaction between predictors and outcomes is challenging when using composite score outcome measures, particularly when variables included in the score are also identified as a predictor of that score. All the disease activity outcome measures used in RA are composite measures, and some of the predictors identified in this review, and the review by Katchamart et al. ADDIN PAPERS2_CITATIONS <citation><uuid>BE2E7361-197D-4E49-A825-4A7AF0216F64</uuid><priority>0</priority><publications><publication><uuid>31F84319-4E61-4116-951E-EA56799E4015</uuid><volume>62</volume><doi>10.1002/acr.20188</doi><startpage>1128</startpage><publication_date>99201003161200000000222000</publication_date><url> for remission in rheumatoid arthritis patients: A systematic review</title><number>8</number><subtype>400</subtype><endpage>1143</endpage><bundle><publication><title>Arthritis Care &amp; Research</title><type>-100</type><subtype>-100</subtype><uuid>65140524-52B5-4751-A9A7-055372F0D652</uuid></publication></bundle><authors><author><firstName>Wanruchada</firstName><lastName>Katchamart</lastName></author><author><firstName>Sindhu</firstName><lastName>Johnson</lastName></author><author><firstName>Hsing-Ju</firstName><middleNames>Lucy</middleNames><lastName>Lin</lastName></author><author><firstName>Veerapong</firstName><lastName>Phumethum</lastName></author><author><firstName>Carine</firstName><lastName>Salliot</lastName></author><author><firstName>Claire</firstName><lastName>Bombardier</lastName></author></authors></publication></publications><cites></cites></citation>(5), are also components of these scores. An example of this is the association between higher baseline tender joint count and reduced likelihood of achieving sustained remission. It is unknown if having more tender joints prior to starting anti-TNF is a negative predictor of achieving sustained remission, or whether there is interaction with the composite outcome measure, within which tender joint count comprises a component. This review also identified that higher baseline disease activity was negatively associated with the likelihood of achieving sustained remission; although this association may be on the causal pathway in the relationship between tender joint count and sustained remission. It is possible that composite disease activity scores may not be efficient at measuring reduction in inflammatory burden. Due to the multifaceted nature of a composite outcome measure, non-inflammatory components (such as the global health measure) may reduce the sensitivity in detecting the change in inflammatory activity achieved by anti-TNFs. A surprising finding was that no objective clinical measure (such as the swollen joint count or inflammatory marker) was associated with sustained remission. It may be that improvements in objective measures of disease activity improve more uniformly in response to anti-TNF in the majority of patients, whereas the more subjective components of the disease activity score and patient directed outcome measures (such as the HAQ) are more variable in their response to anti-TNF. The world health organisation international classification of functioning, disability and health (WHO-ICF) ADDIN PAPERS2_CITATIONS <citation><uuid>BBAA8C3B-0E0F-47CB-9413-F43864478EF3</uuid><priority>0</priority><publications><publication><type>400</type><publication_date>99200100001200000000200000</publication_date><title>International Classification of Functioning, Disability and Health</title><url>;(33) recognises the multi-faceted nature of an individual’s perception of health, disability and functioning, and may provide some insight as to why there appears to be no association between sustained remission and objective measures of disease activity. In the WHO-ICF model, the actual health condition only accounts for one of six dimensions that contribute to an individual’s perception of health and functioning. Participation in life situations, limitations on ability to undertake activities, impairment to body functions, environmental aids or barriers and personal factors all interact in an individual’s perception of health. Quantification and reporting quality of life (such as fatigue) is a problem encountered in many chronic conditions and a recent Cochrane review demonstrated modest improvement in fatigue in response to anti-TNF and other biologic therapy ADDIN PAPERS2_CITATIONS <citation><uuid>9BB5DDC9-F8E1-4A99-8D5B-654D0849FDD2</uuid><priority>0</priority><publications><publication><volume>6</volume><publication_date>99201606061200000000222000</publication_date><doi>10.1002/14651858.CD008334.pub2</doi><institution>Faculty of Health &amp; Life Sciences, University of the West of England, Courtyard Building, BRI, Bristol, UK, BS2 8HW.</institution><startpage>CD008334</startpage><title>Biologic interventions for fatigue in rheumatoid arthritis.</title><uuid>40024499-62A3-4DEF-8AED-8340AC154D32</uuid><subtype>400</subtype><type>400</type><url> Cochrane database of systematic reviews</title><type>-100</type><subtype>-100</subtype><uuid>0B898279-E89A-4B89-A489-93F80661FFBC</uuid></publication></bundle><authors><author><firstName>Celia</firstName><lastName>Almeida</lastName></author><author><firstName>Ernest</firstName><middleNames>HS</middleNames><lastName>Choy</lastName></author><author><firstName>Sarah</firstName><lastName>Hewlett</lastName></author><author><firstName>John</firstName><middleNames>R</middleNames><lastName>Kirwan</lastName></author><author><firstName>Fiona</firstName><lastName>Cramp</lastName></author><author><firstName>Trudie</firstName><lastName>Chalder</lastName></author><author><firstName>Jon</firstName><lastName>Pollock</lastName></author><author><firstName>Robin</firstName><lastName>Christensen</lastName></author></authors></publication></publications><cites></cites></citation>(34). However, a cross-sectional evaluation of the British Society for Rheumatology Biologics Registry for RA (BSRBR-RA) investigating fatigue remission identified that only 37% of those individuals who achieved DAS28 remission at 6 months achieved a corresponding remission of their fatigue ADDIN PAPERS2_CITATIONS <citation><uuid>67DED928-BD95-41D4-B979-BB0018F530F7</uuid><priority>0</priority><publications><publication><publication_date>99201606211200000000222000</publication_date><doi>10.1093/rheumatology/kew241</doi><institution>Musculoskeletal Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK.</institution><title>Most patients who reach disease remission following anti-TNF therapy continue to report fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis.</title><uuid>BC804057-B53E-4332-9C9E-B69321C2126B</uuid><subtype>400</subtype><submission_date>99201511181200000000222000</submission_date><type>400</type><url> University Press</publisher><title>Rheumatology (Oxford, England)</title><type>-100</type><subtype>-100</subtype><uuid>38B8DB8B-2E23-49A3-81DD-FAD32CC17085</uuid></publication></bundle><authors><author><firstName>Katie</firstName><middleNames>L</middleNames><lastName>Druce</lastName></author><author><firstName>Yagnaseni</firstName><lastName>Bhattacharya</lastName></author><author><firstName>Gareth</firstName><middleNames>T</middleNames><lastName>Jones</lastName></author><author><firstName>Gary</firstName><middleNames>J</middleNames><lastName>Macfarlane</lastName></author><author><firstName>Neil</firstName><lastName>Basu</lastName></author></authors></publication></publications><cites></cites></citation>(35). All the composite outcome measures included in this review contain components that indirectly measure non-disease dimensions (the global health measure). Personal factors also contribute to a patient’s reporting of these subjective components. Therefore, the reduction in inflammatory burden could be offset by a lack of effect on subjective components of the score, which may not be directly related to disease activity. This poses wider questions for the use of composite outcome measures to quantify therapeutic efficacy of a targeted drug such as anti-TNF. Whilst blockade of the TNF pathway reduces joint damage, inflammation and swelling of active RA, it may be that a patient’s pain and fatigue is driven by other factors unrelated to their RA. In these cases, classifying the patient as a ‘non-responder’ to anti-TNF is inappropriate. However, none of the studies identified in this review presented data on possible confounders such as fatigue, so we are unable to comment on the relationship between such factors and sustained remission. A future approach for identifying the impact of non-inflammatory factors in the composite outcome measure may be to measure key quality of life metrics (such as fatigue, mood etc.) at two six monthly intervals prior to addition of anti-TNF therapy, with subsequent regular measurement thereafter. If reductions in objective markers of inflammation are noted, but subjective markers and quality of life measures remain poor, therapies targeted at addressing quality of life factors may be more efficacious in eliciting a favourable outcome than switching RA treatment modality. ConclusionsDespite the clinical relevance sustained remission remains a poorly reported outcome. Reporting the number of patients in a sustained state of remission or low disease activity, and their clinical features, would not require any additional data collection than currently occurs in most clinical studies, and would greatly assist in assessing the real-world clinical benefit of these treatments to patients. Furthermore, understanding of how individual components of composite outcome measures (such as the DAS28) vary in response to disease modifying treatment is needed in order to appropriately tailor treatment to the individual.With the increasingly widespread use of anti-TNF therapy, and aspirations of moving towards personalised medicine, understanding which patients achieve the most profound and durable therapeutic effect is essential to ensuring high quality and cost-effective management decisions, as well as considering the wider context in which an individual’s disease sits. Word Count 3608 (Main body of text)AcknowledgementsThis work was conducted on behalf of BSR and the author would like to thank BSR for its help and supportReferences ADDIN PAPERS2_CITATIONS <papers2_bibliography/>1.Grigor C, Capell H, Stirling A, McMahon AD, Lock P, Vallance R, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004 Jul;364(9430):263–9. 2.Goekoop-Ruiterman YPM, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJSM, Hazes JMW, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 2005;52(11):3381–90. 3.Smolen JS, Landewé R, Breedveld FC, Buch M, Burmester G, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis; 2013;0:1–18. doi:10.1136/annrheumdis-2013-204573. 4.Boers M, Kirwan JR, Tugwell P. The OMERACT Handbook. 2015. p124 . 5.Katchamart W, Johnson S, Lin H-JL, Phumethum V, Salliot C, Bombardier C. Predictors for remission in rheumatoid arthritis patients: a systematic review. Arthritis Care Res. 2010 Mar 16;62(8):1128–43. 6.Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev.; 2015;4(1):1. 7.Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Vol. 6, PLoS medicine; 2009. p. e1000097. 8.Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–24. 9.Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis.; 2010 Sep;69(9):1580–8. 10.Van der Heijde DM, van 't Hof MA, Van Riel PL, Theunisse LA, Lubberts EW, Van Leeuwen MA, et al. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis.; 1990 Nov;49(11):916–20. 11.Prevoo ML, van 't Hof MA, Kuper HH, Van Leeuwen MA, Van de Putte LB, Van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1994 Aug 30;38(1):44–8. 12.Fransen J, Welsing P, De Keijzer R, Van Riel PCLM. Disease activity scores using C-reactive protein: CRP may replace ESR in the assessment of RA disease activity. EULAR 2003; Available from: [accessed 2016 Aug 9].13.Aletaha D, Nell VPK, Stamm T, Uffmann M, Pflugbeil S, Machold K, et al. Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther.; 2005;7(4):R796–806. 14.Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, Eberl G, et al. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology (Oxford). 2003 Feb;42(2):244–57. 15.Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LHD, Funovits J, et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum.; 2011 Feb 3;63(3):573–86. 16.Pinals RS, Masi AT, Larsen RA. Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum.; 1981;24(10):1308–15. 17.Wells G, Shea B, O'Connell D, Peterson J, Welch V. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. 2008 [accessed 2016 Aug 9]. Available from: C. Review Manager (RevMan)[Computer Program] Version 5.2. 3. Copenhagen: The Nordic Cochrane Centre; 2012. 2014. 19.Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. 2008. 20.Barnabe C, Homik J, Barr SG, Martin L, Maksymowych WP. The effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy. J Rheumatol.; 2014 Aug;41(8):1607–13. 21.Furst DE, Pangan AL, Harrold LR, Chang H, Reed G, Kremer JM, et al. Greater likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: Results from the Consortium of Rheumatology Researchers of North America registry. Arthritis Care Res.; 2011 May 31;63(6):856–64. 22.Brocq O, Millasseau E, Albert C, Grisot C, Flory P, Roux C-H, et al. Effect of discontinuing TNF-alpha antagonist therapy in patients with remission of rheumatoid arthritis. Joint Bone Spine; 2009 Jul;76(4):350–5. 23.Tanaka Y, Hirata S, Kubo S, Fukuyo S, Hanami K, Sawamukai N, et al. Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study. Ann Rheum Dis.; 2015 Feb;74(2):389–95. 24.Balogh E, Madruga Dias J, Orr C, Mullan R, Harty L, FitzGerald O, et al. Comparison of remission criteria in a tumour necrosis factor inhibitor treated rheumatoid arthritis longitudinal cohort: patient global health is a confounder. Arthritis Res Ther.; 2013;15(6):R221. 25.Einarsson JT, Geborek P, Saxne T, Kapetanovic MC. Sustained Remission in Tumor Necrosis Factor Inhibitor-treated Patients with Rheumatoid Arthritis: A Population-based Cohort Study. J Rheumatol.; 2015 May;42(5):741–8. 26.Brocq O, Millasseau E, Albert C, Grisot C, Flory P, Roux C-H, et al. Effect of discontinuing TNF alpha; antagonist therapy in patients with remission of rheumatoid arthritis. Joint Bone Spine; 2009 Jul 1;76(4):350–5. 27.Navarro-Millan I, Chen L, Greenberg JD, Pappas DA, Curtis JR. Predictors and persistence of new-onset clinical remission in rheumatoid arthritis patients. Semin Arthritis Rheu.; 2013 Oct 1;43(2):137–43. 28.Kristensen LE, Saxne T, Geborek P. The LUNDEX, a new index of drug efficacy in clinical practice: Results of a five-year observational study of treatment with infliximab and etanercept among rheumatoid arthritis patients in southern Sweden. Arthritis Rheum. 2006;54(2):600–6. 29.Wetteland P, R?ger M, Solberg HE, Iversen OH. Population-based erythrocyte sedimentation rates in 3910 subjectively healthy Norwegian adults. A statistical study based on men and women from the Oslo area. J Intern Med. 1996 Sep;240(3):125–31. 30.Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a tumour necrosis factor inhibitor. Health Technol Assess [Internet]. 2010. Available from: [accessed 2016 Aug 9].31.Avina-Zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis.; 2012 Sep;71(9):1524–9. 32.Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Fleming P, et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann Rheum Dis.; 2015 Mar;74(3):480–9. 33.World Health Organization. Towards a common language for functioning, disability and health: ICF. 2002 [Internet]. Available at: ; 2005 [accessed 2016 Aug 9]. 34.Almeida C, Choy EH, Hewlett S, Kirwan JR, Cramp F, Chalder T, et al. Biologic interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev. 2016 Jun 6;6:CD008334. 35.Druce KL, Bhattacharya Y, Jones GT, Macfarlane GJ, Basu N. Most patients who reach disease remission following anti-TNF therapy continue to report fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Rheumatology (Oxford). 2016 Jun 21. 36.Brocq O, Roux C-H, Albert C, Breuil V, Aknouche N, Ruitord S, et al. TNFα antagonist continuation rates in 442 patients with inflammatory joint disease. Joint Bone Spine. 2007 Mar;74(2):148–54. Table SEQ Table \* ARABIC 1. Newcastle-Ottawa Quality ScoringScoreAcceptableBrocq 2009Furst 2011Balogh 2013Barnabe 2014Einarsson2015Tanaka 2015SelectionRepresentativeness of the exposed cohortTruly or somewhat representative of the average RA patient using anti-TNF in the communityNil*Nil**NilRepresentativeness of the non-exposed cohortDrawn from the same community as the exposed cohort******Ascertainment of exposureSecure record or structured interview******Demonstration that the outcome was not present at the start of the studyDocumented that patients were not in remission at the time of entry***NilNil*ComparabilityComparability of cohortsSubgroups (exposed and non-exposed) were drawn from the same cohort (2 stars)************OutcomeAssessment of outcomeIndependent blind assessment or record linkage******Was follow-up long enough for outcome to occurAt least 6 months follow-up after the first review following baseline visit ******Adequacy of follow-upAll subjects accounted for or <10% of patients lost to follow-up (unless detailed description that those lost to follow-up would not have introduced bias)NilNil****SummarySelection (Max 4 *)*******************Comparability (Max 2*)************Outcome (Max 3*)****************Table SEQ Table \* ARABIC 2. Summary of Studies & Baseline Characteristics Author, yearCountryStudy Duration & DesignSample Size & Gender (Female)Anti-TNF group inclusion criteriaCo-medication (included/excluded)Mean Age & disease duration (yrs)Disease activity measureMean +/- SD disease activityHAQ score, mean or median +/- SD or (range)Proportion of Cohort in Sustained Remission (%), CriteriaBrocq 2009France7 years, Retrospective Cohort304, 81.3%1 RA patients with failure of methotrexate and DAS28 ≥ 5.1. Previous anti-TNF treatment allowed.IncludedPrednisolone (≤5mg)Synthetic DMARD (stable dose)Excluded NSAID users58, 10 1DAS286.41 Not given8.2% DAS28Furst 2011USA7 years, Prospective Cohort (stratified by disease duration)3170, 77.4-79.8% (depending on subgroup)RA patients starting on anti-TNFIncludedSynthetic DMARD (dose unspecified)ExcludedNone specified54.3, 2.5DAS284.4 ± 1.4M-HAQ values0.5 (mean) ± 0.5 (SD)8.9%, DAS28Overall cohort sustained remission 7.6% by CDAI and 7.9% by DAS28CDAI21.8 ± 13.79.7%, CDAI54.1, 7.7DAS284.5 ± 1.50.5 (mean) ± 0.5 (SD)11.6%, DAS28CDAI21.0 ± 13.89.5%, CDAI60.5, 20.3DAS284.6 ± 1.50.6 (mean) ± 0.5 (SD)4.9%, DAS28CDAI21.5 ± 13.14.2%, CDAIBalogh 2013Ireland1 year, Prospective Cohort 273, 74.4%Biologic na?ve RA patients with persistent disease activity starting on anti-TNFNone specified59.9, 13.4DAS28,ACR/EULAR5.33 ± 1.07Not given9.9%, DAS28 (from ACR/EULAR subgroup)Barnabe 2014Canada7 years, Prospective Cohort1116, 74.0%Biologic na?ve, RA refractory to parenteral methotrexate/ leflunomide, at least 2 study visitsNone specified54.4, 12.2DAS286.03 ± 1.301.62 (mean), 0.6821.5%, DAS28 CDAI38.52 ± 13.599.9%, CDAISDAI40.90 ± 14.664.5%, SDAIACR/EULAR 2011 (no CRP)NA10.8%, ACR/EULAR 2011 (minus CRP component) ACR/EULAR NA6.8%, ACR/EULAR 2011 Tanaka 2015Japan3 years, Open label, non-randomised study197, 84.8%RA patients with inadequate response (DAS28-ESR ≥3.2) to Methotrexate and/or other non-biological DMARDsIncludedNone specifiedExcludedSteroid useNSAID and Coxib useVariable synthetic DMARD use60.7, 8.9DAS28-ESR5.4 Not given38.1%, DAS28-ESR Einarsson 2015Sweden10 years, Prospective cohort2416, 77%RA patients with active disease + ≥1 failed previous DMARD. Previous biologic allowed.None specified56.0, 11.8DAS285.5 1.3 (mean)15.8%, DAS28Table 3. Predictors of sustained remission Study (n)PredictorOutcome Measure UsedEffect SizeAssociation with Sustained RemissionBarnabe 2014(1116)Baseline Physician Global (High)DAS28OR 0.80, 95% CI 0.66–0.99NegativeObesityACR/EULAR Boolean (excluding CRP)OR 0.30, 95% CI 0.10–0.90 Tender Joint Count (High)CDAIOR 0.96, 95% CI 0.92–1.00 Early response to treatment (<16 weeks)DAS28OR 1.88, 95% CI 1.27 – 2.78PositiveFurst 2011(3179)Higher baseline disease activity DAS28OR 0.37, 95% CI 0.19 – 0.73 NegativeCDAIOR 0.57, 95% CI 0.39 – 0.84DisabilityCDAIOR 0.25, 95% CI 0.08 – 0.79Increased disease duration (5-yearly increments) CDAI (but not by DAS28)OR 0.85, 95% CI 0.75 – 0.97Age DAS28 (but not by CDAI)OR 0.79, 95% CI 0.63 – 1.00Female genderDAS28 (but not by CDAI)OR 0.43, 95% CI 0.23 – 0.82Concomitant prednisolone CDAI (but not by DAS28)OR 0.69, 95% CI 0.47 – 1.00Prior anti-TNF useCDAIOR 0.98, 95% CI, 0.96 – 1.00DAS28OR 0.72, 95% CI, 0.54 – 0.94Concomitant methotrexateCDAIOR 1.55, 95% CI 1.00 – 2.42PositiveDAS28OR 2.83, 95% CI 1.18 – 6.80 Balogh, 2013(273)Tender Joint CountDAS28 (as a subgroup of ACR/EULAR criteria)OR 0.910, p 0.031NegativeIncreasing AgeOR 0.942, p<0.0001Tanaka 2015 (197)Lower Patient Global ScoreDAS28-ESR41.3 vs. 54.9 mm, p=0.0004PositiveShorter disease duration7.5 vs. 9.6 yrs, p= 0.005Lower baseline HAQ-DI score 0.96 vs. 1.42, p<0.0001Lower baseline ESR44.1mm/hr vs. 53.0 mm/hr, p=0.0374Lower baseline DAS28-ESR5.11 vs. 5.70, p=0.005Einarsson 2015(2416)Female GenderDAS28OR 0.57, 95% CI 0.44 – 0.75NegativeHigher baseline disease activityOR 0.62, 95% CI 0.55 – 0.70Earlier calendar year of starting anti-TNF OR 0.89, 95% CI 0.85 – 0.93Higher HAQOR 0.39, 95%?CI 0.31 – 0.49Increasing age OR 0.98, 95% CI 0.97 – 0.99Concomitant Methotrexate OR 2.02, 95% CI 1.51 – 2.71PositiveSupplementary Online Table 1. Medline Search Criteria Diagnosis (KW.)Drug (OR, KW.)Outcome (OR, KW.)Rheumatoid arthritis(74933)ANDTumor necrosis factors* (2066)Tumor Necrosis factor-alpha* (116033)Antibodies, Monoclonal* (180019)Antibodies, Monoclonal, Humanized* (25271)Antibodies, Monoclonal, Murine-Derived* (9706)Receptors, Tumor Necrosis Factor* (16571)Certolizumab pegol. kw (373) Golimumab. kw (326) Infliximab. kw (8655) CT-P13* (Infliximab biosimilar). kw (3)Adalimumab. kw (3549) Etanercept. kw (4027)Anti-TNF .kw (6196)Tnf.kw (108867)TNFR-Fc fusion protein .kw (4201)Combined hits with OR 328541Diagnosis AND Drug combined give 10829 hitsANDRemission, Spontaneous* (15099)Treatment outcome* (658026)Severity of illness Index* (171810)Reproducibility of Results* (281754)Remission Induction* (32979)Induction Chemotherapy* (5743)Recovery of Function* (34252)Pharmacology, clinical* (2201)Drug evaluation* (80081)Drug utilization* (20410)Evaluation Studies as Topic* (119716)Maintenance Chemotherapy* (1435)Quality of Health Care* (115945)Sustained remission (kw) (930)Maintained remission (kw) (130)Prolonged remission (kw) (611)Responder (kw) (10266)Disease control (kw) (46264)Disease activity (kw) (24636)DAS28 (kw) (1474)Clinical Disease Activity Index (kw) (184)Simplified Disease Activity Index (kw) (128)DAS (kw) (42944)Remission (kw) (109223)Combined above hits with OR 1676984*Denotes MeSH heading(kw) denotes keywordSearch Performed using Ovid interface on 4th September 2015All above articles were searched as keywords- Diagnosis AND Drug AND Outcome gives 3797 hits Limit to humans, and adolescent, all adult, young adult, middle age, middle aged, all aged, aged- gives 2413 hitsFigure SEQ Figure \* ARABIC 1. Results of Citation Screening Figure SEQ Figure \* ARABIC 2. (a) Effect of gender on likelihood of achieving sustained remission and (b) publication bias ................
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