Comparison and application of rheumatoid arthritis remission criteria / 医学研究生学报

Rheumatoid arthritis ( RA) is a kind of autoimmune disease with high morbidity characterized in synovitis.It has become a key goal for achieving an early RA remission.It is very important for application of RA remission normatively in the treatment of RA.In this paper, comparison and application of various RA remission criteria were reviewed, such as American College of Rheu-matology (ACR), European League Against Rheumatism (EULAR), US Food and Drug Administration (FDA), Outcome Measures in Rheumatoid Arthritis Clinical Trials ( OMERACT) group, ACR /EULAR remission criteria, etc.

Criteria of cure and remission in Cushing's disease: an update: [review]

We review the clinical and biochemical criteria used for evaluation of the transsphenoidal pituitary surgery results in the treatment of Cushing's disease (CD). Firstly, we discuss the pathophysiology of the hypothalamic-pituitary-adrenal axis in normal subjects and patients with CD. Considering the series published in the last 25 years, we observed a significant variation in the remission or cure criteria, including the choice of biochemical tests, timing, threshold values to define remission, and the interference of glucocorticoid replacement or previous treatment. In this context we emphasize serum cortisol levels obtained early (from hours to 12 days) in the postoperative period without any glucocorticoid replacement or treatment. Our experience demonstrates that: (i) early cortisol < 5 to 7 µg/dl, (ii) a period of glucocorticoid dependence > 6 mo, (iii) absence of response of cortisol/ACTH to CRH or DDAVP, (iv) return of dexamethasone suppression, and circadian rhythm of cortisol are appropriate indices of remission of CD. In patients with undetectable cortisol levels early after surgery, recurrence seems to be low. Finally, although certain biochemical patterns are more suggestive of remission or surgical failure, none has been proven to be completely accurate, with recurrence observed in approximately 10 to 15 percent of the patients in long-term follow-up. We recommended that patients with CD should have long-term monitoring of the CRH-ACTH-cortisol axis and associated co-morbidities, especially hypopituitarism, diabetes mellitus, hypertension, cardiovascular disturbances, and osteoporosis.

Neste artigo, são revisados os principais critérios clínicos e hormonais utilizados para avaliação do tratamento cirúrgico da Doença de Cushing (DC). Inicialmente são comentados aspectos fisiopatológicos que orientam a avaliação hormonal e os principais fatores clínicos, laboratoriais, cirúrgicos e histológicos associados com melhores resultados, observados nas principais séries da literatura e em pacientes acompanhados prospectivamente pelos autores. Foram revisados, também, critérios adotados nas principais séries da literatura, nos últimos 25 anos, chamando-se atenção para as dosagens hormonais, o momento em que foram realizadas, a possibilidade de interferência de tratamentos prévios e da reposição glicocorticóide. À seguir, essas dosagens são discutidas salientando-se a importância do cortisol obtido seqüencialmente no pós-operatório e sem a interferência de reposição glicocorticóide. A experiência prospectiva dos autores, recentemente referendada na literatura, demonstra que valores de cortisol < 5 a 7 µg/dl associados com um período de dependência aos glicocorticóides > 6 meses, ausência de resposta do ACTH/cortisol ao DDAVP e/ou CRH, retorno da supressão à dexametasona e do ritmo circadiano, estão associados com remissão da DC. Em pacientes com cortisol indetectável após cirurgia transesfenoidal, a chance de recidiva parece ser menor do que naqueles em que se observa cortisol detectável. Finalmente, chamamos a atenção para que, mesmo adotando critérios rígidos de avaliação, a recidiva da DC pode ocorrer a longo prazo em até 15 por cento dos casos, recomendando-se, portanto, que esses pacientes sejam acompanhados por tempo indeterminado, com monitorização cuidadosa do eixo CRH-ACTH-cortisol e de suas co-morbidades, especialmente hipopituitarismo, diabete melito, hipertensão arterial, alterações cardiovasculares e osteoporose.

Remission Rates and Criteria for Clinical Studies on Schizophrenia / 대한정신약물학회지

OBJECTIVE: Standardizing remission criteria is helpful for documenting patient remission states by setting appropriate treatment goals and comparing the efficacy of various therapies. We investigated the applicability of two remission criteria through a 1-year prospective observational study on patients with recent-onset schizophrenia. METHODS: Forty-nine patients were enrolled and assessed monthly using the BPRS, SAPS, SANS, and CGI. Criteria A included a BPRS total score of < or =36, a BPRS psychotic item score of < or =3, and a CGI-S score of < or =3. Criteria B included all of five global items in the SAPS and SANS of < or =2 (mild). Each remission criterion was required to be met for at least 2 consecutive months. RESULTS: The remission rates at study endpoint were 64.3 and 42.9%, respectively, when criteria A and B were applied. Within criteria A, the remission rate was 78.6% when only a BPRS total score criterion was applied, which then dropped to 75.0% when a BPRS psychotic item criterion was added. A 75% remission rate was noted when the CGI criterion was independently applied. Within criteria B, a 71.4% remission rate was observed using the SAPS criterion, which decreased to 42.9% when a SANS score criterion was added. No significant difference was detected in the time to remission and the duration of maintained remission when criteria A or B were applied. CONCLUSION: The SAPS and SANS scales are stricter for categorizing the remission state compared to the BPRS and CGI. Criteria based on the BPRS appear to be more representative of the remission state when a BPRS psychotic item criterion is added. In addition, CGI alone can be used for longterm follow-up evaluations of patients with schizophrenia.