Ricardo J O Ferreira1, Cátia Duarte2, Mwidimi Ndosi3, Maarten de Wit4, Laure Gossec5, J A P da Silva2. 1. Centro Hospitalar e Universitário de Coimbra and Health Sciences Research Unit: Nursing, Coimbra, Portugal. 2. Centro Hospitalar e Universitário de Coimbra and University of Coimbra, Coimbra, Portugal. 3. University of the West of England, Bristol, UK. 4. Patient research partner, EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland, and VU University Medical Centre, Amsterdam, The Netherlands. 5. Sorbonne Universités, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and AP-HP, Pitié-Salpetrière Hospital, Paris, France.
Abstract
OBJECTIVE: In current management paradigms of rheumatoid arthritis (RA), patient global assessment (PGA) is crucial to decide whether a patient has attained remission (target) or needs reinforced therapy. We investigated whether the clinical and psychological determinants of PGA are appropriate to support this important role. METHODS: This was a cross-sectional, single-center study including consecutive ambulatory RA patients. Data collection comprised swollen 28-joint count (SJC28), tender 28-joint count (TJC28), C-reactive protein (CRP) level, PGA, pain, fatigue, function, anxiety, depression, happiness, personality traits, and comorbidities. Remission was categorized using American College of Rheumatology/European League Against Rheumatism Boolean-based criteria: remission, near-remission (only PGA >1), and nonremission. A binary definition without PGA (3v-remission) was also studied. Univariable and multivariable analyses were used to identify explanatory variables of PGA in each remission state. RESULTS: A total of 309 patients were included (remission 9.4%, near-remission 37.2%, and nonremission 53.4%). Patients in near-remission were indistinguishable from remission regarding disease activity, but described a disease impact similar to those in nonremission. In multivariable analyses, PGA in near-remission was explained (R2adjusted = 0.50) by fatigue, pain, anxiety, and function. Fatigue and pain had no relationship with disease activity measures. CONCLUSION: In RA, a consensually acceptable level of disease activity (SJC28, TJC28, and CRP level ≤1) does not equate to low disease impact: a large proportion of these patients are considered in nonremission solely due to PGA. PGA mainly reflects fatigue, pain, function, and psychological domains, which are inadequate to define the target for immunosuppressive therapy. This consideration suggests that clinical practice should be guided by 2 separate remission targets: inflammation (3v-remission) and disease impact.
OBJECTIVE: In current management paradigms of rheumatoid arthritis (RA), patient global assessment (PGA) is crucial to decide whether a patient has attained remission (target) or needs reinforced therapy. We investigated whether the clinical and psychological determinants of PGA are appropriate to support this important role. METHODS: This was a cross-sectional, single-center study including consecutive ambulatory RApatients. Data collection comprised swollen 28-joint count (SJC28), tender 28-joint count (TJC28), C-reactive protein (CRP) level, PGA, pain, fatigue, function, anxiety, depression, happiness, personality traits, and comorbidities. Remission was categorized using American College of Rheumatology/European League Against Rheumatism Boolean-based criteria: remission, near-remission (only PGA >1), and nonremission. A binary definition without PGA (3v-remission) was also studied. Univariable and multivariable analyses were used to identify explanatory variables of PGA in each remission state. RESULTS: A total of 309 patients were included (remission 9.4%, near-remission 37.2%, and nonremission 53.4%). Patients in near-remission were indistinguishable from remission regarding disease activity, but described a disease impact similar to those in nonremission. In multivariable analyses, PGA in near-remission was explained (R2adjusted = 0.50) by fatigue, pain, anxiety, and function. Fatigue and pain had no relationship with disease activity measures. CONCLUSION: In RA, a consensually acceptable level of disease activity (SJC28, TJC28, and CRP level ≤1) does not equate to low disease impact: a large proportion of these patients are considered in nonremission solely due to PGA. PGA mainly reflects fatigue, pain, function, and psychological domains, which are inadequate to define the target for immunosuppressive therapy. This consideration suggests that clinical practice should be guided by 2 separate remission targets: inflammation (3v-remission) and disease impact.
Authors: Ethan T Craig; Jamie Perin; Scott Zeger; Jeffrey R Curtis; Vivian P Bykerk; Clifton O Bingham; Susan J Bartlett Journal: Arthritis Care Res (Hoboken) Date: 2020-11 Impact factor: 4.794
Authors: Eduardo José Ferreira Santos; Cátia Duarte; Ricardo J O Ferreira; Ana Margarida Pinto; Rinie Geenen; Jose A P da Silva Journal: Ann Rheum Dis Date: 2018-04-06 Impact factor: 19.103
Authors: Ricardo J O Ferreira; Laure Gossec; Cátia Duarte; Joanne K Nicklin; Sarah Hewlett; J A P da Silva; Mwidimi Ndosi Journal: Qual Life Res Date: 2018-08-01 Impact factor: 4.147