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Remission vs LDA — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisRemission vs LDASCE Rheumatology

A 55-year-old man with rheumatoid arthritis asks about the practical difference between remission and low disease activity as treatment targets. According to current EULAR recommendations, which statement is most accurate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Remission is preferred in early RA; low disease activity is acceptable in established disease.

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as E

E is correct. EULAR uses a treat-to-target strategy aiming for sustained remission or low disease activity. Remission is the preferred and more stringent target, particularly in early RA, whereas sustained low disease activity is an acceptable practical target in established or long-standing disease when remission is difficult to achieve. Remission should be assessed using ACR/EULAR Boolean-based or validated index-based criteria; DAS28 below 2.6 is a less stringent historical threshold and is not the sole ACR/EULAR definition. Remission means control of inflammatory disease activity, not cure, and it does not justify immediate DMARD withdrawal. Therefore A and B reverse or erase the clinically relevant hierarchy, while C and D misstate the meaning and measurement of remission.

Reference: Smolen JS et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biologic disease-modifying antirheumatic drugs: 2025 update, treatment-target recommendation, 2026. https://ard.bmj.com/content/82/1/3