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Background <p>Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease in which achieving remission is the most effective strategy to prevent progression and optimize long-term outcomes. The performance of commonly used disease activity indices has not been well validated in the Brazilian RA population. This study aimed to evaluate the agreement between CDAI/SDAI and the revised Boolean 2.0 remission criteria, which served as the reference standard, and to identify the most accurate CDAI and SDAI remission cut-offs in this population.</p> Methods <p>We conducted a cross-sectional analysis of baseline data from a Brazilian Cohort study, which included 840 patients from 11 public hospitals in Brazil. Disease activity was assessed using DAS28-CRP, DAS28-ESR, SDAI, CDAI, and Boolean 1.0/2.0. Agreement was assessed using Cohen’s kappa, and optimal remission cut-offs were determined through ROC curve analysis.</p> Results <p>The study population was predominantly female (89.8%), with a mean age of 57 years and a median disease duration of 12 years. DAS28-CRP showed the highest remission rate (39.2%), whereas Boolean 1.0 showed the lowest (15.1%). Strong agreement was found between Boolean 2.0, and both the SDAI (κ = 0.775) and CDAI (κ = 0.692). ROC analysis revealed that the most accurate remission cut-offs were SDAI ≤ 4.3 and CDAI ≤ 3.9, which increased remission detection by 5.9% and 6.2%, respectively.</p> Conclusion <p>In our cohort, SDAI ≤ 4.3 and CDAI ≤ 3.9 were the values most closely aligned with Boolean 2.0 remission. These adjusted cut-offs may help minimize overtreatment in resource-limited settings. Prospective studies assessing function, radiographic progression, and quality of life are warranted to confirm their validity in the Brazilian population.</p>

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Are global definitions enough? Revisiting CDAI and SDAI remission cut-offs in Brazilian Rheumatoid Arthritis patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月13日

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  • Lucas Castro Pires,
  • Alisson Pugliesi,
  • Cleandro Pires de Albuquerque,
  • Vitor Alves Cruz,
  • Manoel Barros Bertolo,
  • Ana Paula Monteiro Gomides Reis,
  • Rina Dalva Neubarth Giorgi,
  • Leticia Rocha Pereira,
  • Sebastião Cezar Radominski,
  • Ivanio Alves Pereira,
  • Maria Fernanda Resende Guimarães,
  • Paulo Louzada Junior,
  • Maria de Fátima Lobato da Cunha Sauma,
  • Karina Rossi Bonfiglioli,
  • Claiton Viegas Brenol,
  • Licia Maria Henrique da Mota,
  • Geraldo da Rocha Castelar Pinheiro

摘要

Background

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease in which achieving remission is the most effective strategy to prevent progression and optimize long-term outcomes. The performance of commonly used disease activity indices has not been well validated in the Brazilian RA population. This study aimed to evaluate the agreement between CDAI/SDAI and the revised Boolean 2.0 remission criteria, which served as the reference standard, and to identify the most accurate CDAI and SDAI remission cut-offs in this population.

Methods

We conducted a cross-sectional analysis of baseline data from a Brazilian Cohort study, which included 840 patients from 11 public hospitals in Brazil. Disease activity was assessed using DAS28-CRP, DAS28-ESR, SDAI, CDAI, and Boolean 1.0/2.0. Agreement was assessed using Cohen’s kappa, and optimal remission cut-offs were determined through ROC curve analysis.

Results

The study population was predominantly female (89.8%), with a mean age of 57 years and a median disease duration of 12 years. DAS28-CRP showed the highest remission rate (39.2%), whereas Boolean 1.0 showed the lowest (15.1%). Strong agreement was found between Boolean 2.0, and both the SDAI (κ = 0.775) and CDAI (κ = 0.692). ROC analysis revealed that the most accurate remission cut-offs were SDAI ≤ 4.3 and CDAI ≤ 3.9, which increased remission detection by 5.9% and 6.2%, respectively.

Conclusion

In our cohort, SDAI ≤ 4.3 and CDAI ≤ 3.9 were the values most closely aligned with Boolean 2.0 remission. These adjusted cut-offs may help minimize overtreatment in resource-limited settings. Prospective studies assessing function, radiographic progression, and quality of life are warranted to confirm their validity in the Brazilian population.