Impact of remission definitions on residual symptom burden assessed using the Okomarigoto Sheet in rheumatoid arthritis: a comparison between Boolean 1.0 and Boolean 2.0.

OBJECTIVES: This study examined whether adopting the Boolean 2.0 remission criteria results in the inclusion of patients with a higher burden of residual symptoms (RS) in rheumatoid arthritis (RA). It also aimed to characterize differences in RS burden across remission definitions. METHODS: This cross-sectional, single-center study included 400 consecutive patients with RA. RSs were assessed using the Okomarigoto Sheet (OS), which evaluates pain, morning stiffness, and fatigue. Clinical remission was defined using the Disease Activity Score in 28 joints with C-reactive protein (DAS28-CRP), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and Boolean 1.0 and 2.0 criteria. The primary outcome was the proportion of patients achieving OS = 0. Mixed-effects logistic regression and subgroup analyses were conducted to compare RS burden across remission definitions. RESULTS: The proportion of patients achieving complete absence of RSs differed across remission definitions, with the highest rate observed in Boolean 1.0 remission (52.7%), followed by Boolean 2.0 (45.0%) and DAS28-CRP (37.5%). Compared with Boolean 1.0 remission, patients meeting Boolean 2.0 but not Boolean 1.0 criteria had significantly higher total and domain-specific OS scores (all p < 0.001). Similar findings were observed among patients achieving DAS28-CRP remission but not Boolean 1.0 remission. Mixed-effects logistic regression indicated no significant difference between Boolean 1.0 and Boolean 2.0 remission in achieving OS = 0. CONCLUSIONS: RS burden in RA varies depending on the remission definition. Boolean 2.0 remission expands the classification of remission and is associated with higher multidimensional residual symptom scores than Boolean 1.0 remission.