Ricardo J O Ferreira1,2, Maxime Dougados3,4,5, John R Kirwan6, Cátia Duarte1,7, Maarten de Wit8,9, Martin Soubrier10, Bruno Fautrel11,12,13, Tore K Kvien14, José A P da Silva1,7, Laure Gossec11,12. 1. Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra. 2. Health Sciences Research Unit: Nursing (UICiSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal. 3. Faculty of Medicine, Paris Descartes University. 4. Department of Rheumatology, AP-HP, Hôpital Cochin. 5. INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France. 6. Academic Rheumatology Unit, Bristol Royal Infirmary, University of Bristol, Bristol, UK. 7. Clínica Universitária de Reumatologia, Faculty of Medicine, University of Coimbra, Coimbra, Portugal. 8. Patient Research Partner, EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland. 9. Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands. 10. Department of Rheumatology, CHU Clermont-Ferrand, Clermont-Ferrand. 11. Faculty of Medicine, UPMC University Paris 06, GRC-UPMC 08 (EEMOIS). 12. Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris. 13. CRI IMIDIATE, French Clinical Research Infrastructure Network, Toulouse, France. 14. Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Abstract
Objectives: ACR/EULAR Boolean remission in RA is frequently not obtained solely due to a patient global assessment (PGA) >1/10 (a condition often designated as near-remission). This study aimed to assess which domains of impact could explain an elevated PGA in near-remission patients. Methods: We performed an ancillary analysis of data from three cross-sectional studies in patients with established RA. Three disease activity states were defined: remission (tender and swollen joint counts, CRP and PGA all ⩽1), near-remission (tender and swollen joint counts, and CRP are all ≤1 but PGA >1) and non-remission. Physical and psychological domains were assessed using the RA Impact of Disease 0-10 (numeric rating scale) as explanatory factors of PGA. Univariable and multivariable linear regression analyses were performed to explain PGA. Results: A total of 1588 patients (79.1% females) were analysed. The mean disease duration was 13.0 years (s.d. 9.8) and the 28-joint DAS with four variables was 3.2 (s.d. 1.4). Near-remission [mean PGA 3.6 (s.d. 1.9)] was more frequent (19.1%) than remission (12.3%). Scores of RA Impact of Disease domains were similar in near-remission and non-remission patients. In near-remission, PGA was explained (R2adjusted = 0.55) by pain (β = 0.29), function (β = 0.23), physical well-being (β = 0.19) and fatigue (β = 0.15). Conclusion: Near-remission was more frequent than remission. These patients, despite having no signs of significant inflammation, report an impact of disease similar to the non-remission patients. PGA in near-remission seems to be driven by physical rather than psychological domains. Selecting the best therapy for these patients requires a better understanding of the meaning of PGA, both globally and in individual patients.
Objectives:ACR/EULAR Boolean remission in RA is frequently not obtained solely due to a patient global assessment (PGA) >1/10 (a condition often designated as near-remission). This study aimed to assess which domains of impact could explain an elevated PGA in near-remission patients. Methods: We performed an ancillary analysis of data from three cross-sectional studies in patients with established RA. Three disease activity states were defined: remission (tender and swollen joint counts, CRP and PGA all ⩽1), near-remission (tender and swollen joint counts, and CRP are all ≤1 but PGA >1) and non-remission. Physical and psychological domains were assessed using the RA Impact of Disease 0-10 (numeric rating scale) as explanatory factors of PGA. Univariable and multivariable linear regression analyses were performed to explain PGA. Results: A total of 1588 patients (79.1% females) were analysed. The mean disease duration was 13.0 years (s.d. 9.8) and the 28-joint DAS with four variables was 3.2 (s.d. 1.4). Near-remission [mean PGA 3.6 (s.d. 1.9)] was more frequent (19.1%) than remission (12.3%). Scores of RA Impact of Disease domains were similar in near-remission and non-remission patients. In near-remission, PGA was explained (R2adjusted = 0.55) by pain (β = 0.29), function (β = 0.23), physical well-being (β = 0.19) and fatigue (β = 0.15). Conclusion: Near-remission was more frequent than remission. These patients, despite having no signs of significant inflammation, report an impact of disease similar to the non-remission patients. PGA in near-remission seems to be driven by physical rather than psychological domains. Selecting the best therapy for these patients requires a better understanding of the meaning of PGA, both globally and in individual patients.
Authors: Rabaa Takala; Dipak P Ramji; Robert Andrews; You Zhou; Mustafa Farhat; Mohammed Elmajee; Shelley Rundle; Ernest Choy Journal: Sci Rep Date: 2022-05-25 Impact factor: 4.996
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