Page 178 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

CHAPTER 10
the ideal moment to assess CV risk management additional research is necessary. For instance, the current literature is contradictory about the effect of prednisolone on the lipid profile. Therefore, an even more optimal moment might be a situation of low dis- ease activity after cessation of prednisolone, but this remains to be shown.
Part III demonstrates that it is difficult to develop a definition of remission that compris- es all of its aspects. Many different definitions exist, and the amount of patients that fulfill these varied widely. After three months of treatment, one-third of the patients disagree with the physician about being in remission. Patients take other domains of disease activity into account (e.g. pain, sleep and emotional wellbeing) than physicians. Patient satisfaction, the relationship between patient and physician, and treatment compliance can all be improved when patient and physician agree on the state of the disease. Therefore, it is important to increase patient involvement in their own health- care decisions, and so improve shared decision making. Physician- and patient-per- ceived remission both had the best agreement with European League Against Rheu- matism (EULAR) good response. However, further research is necessary to determine which definition of response or remission, is best to use in clinical practice and which predicts a good prognosis without leading to overtreatment. Possibly new definitions of remission, with more patient-reported outcomes, can earlier sustain or further improve an optimal state of physical functioning. A good candidate could be the normality scale, as patients indicated returning back to normality as one of the three important domains of remission, and the normality scale is able to discriminate between remission and non-remission. The perception of normality also increased after initiation of anti-rheu- matic treatment. The definition of remission according to the patient is very important, therefore it would be interesting to see if perception of normality will further increase over time and if the normality scale is able to predict disease activity, and eventually might even be able to replace the DAS.
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