Residual symptoms and disease burden among patients with rheumatoid arthritis in remission or low disease activity: a systematic literature review

Objectives: To identify, describe and summarize evidence on residual symptoms and disease burdens in rheumatoid arthritis (RA) patients qualified as being in remission or low disease activity (LDA).Methods: A systematic literature review (SLR) was conducted according to Cochrane collaboration guidelines. The population of interest was adult patients with RA in remission or LDA. The reported outcomes of interest were any symptoms or burdens.Results: Fifty-one publications were identified through an eDatabase search. Together with 17 articles found through other sources, 68 were included for full text review. The most commonly reported residual symptoms were pain (number of studies=25), fatigue (n=21) and morning stiffness (n=5). Reported disease burdens included mental health (n=15), sleep disturbances (n=7) and work productivity (n=5), impairment in quality of life (n=21), and functional disability (n=34). Substantial residual symptoms and disease burdens were found to be present in patients in remission or LDA.Conclusion: This is the first SLR to investigate residual symptoms and disease burdens in RA patients in remission or LDA. The results indicate that despite achieving conventional clinical targets, the disease continues to affect patients, suggesting the existence of unmet need under the current treatment paradigm.