Ricardo J O Ferreira1, Pedro David Carvalho2, Mwidimi Ndosi3, Cátia Duarte4, Arvind Chopra5, Elizabeth Murphy6, Désirée van der Heijde7, Pedro M Machado8, José A P da Silva4. 1. Centro Hospitalar e Universitário de Coimbra, and Nursing School of Coimbra, Coimbra, Portugal. 2. Centro Hospitalar e Universitário do Algarve, Faro, Portugal. 3. University of the West of England and University Hospitals Bristol, Bristol, UK. 4. Centro Hospitalar e Universitário de Coimbra, Coimbra Institute for Clinical and Biomedical Research, and University of Coimbra, Coimbra, Portugal. 5. Centre for Rheumatic Diseases, Pune, India. 6. University Hospital Wishaw, Wishaw, Scotland. 7. Leiden University Medical Centre, Leiden, The Netherlands. 8. University College London, Northwick Park Hospital, and London North West University Healthcare NHS Trust, London, UK.
Abstract
OBJECTIVE: There is an ongoing debate about excluding patient's global assessment (PtGA) from composite and Boolean-based definitions of rheumatoid arthritis (RA) remission. This study aimed at determining the influence of PtGA on RA disease states, exploring differences across countries, and understanding the association between PtGA, measures of disease impact (symptoms), and markers of disease activity (inflammation). METHODS: Cross-sectional data from the Measurement of Efficacy of Treatment in the Era of Outcome in Rheumatology international database were used. We calculated the proportion of patients failing American College of Rheumatology/European League Against Rheumatism Boolean-based remission (4-variable remission) solely due to PtGA (PtGA-near-remission) in the overall sample and in the most representative countries (i.e., those with >3,000 patients in the database). Multivariable linear regression models were used to identify the main determinants of PtGA, grouped in predominantly inflammatory impact factors (28 tender joint counts, 28 swollen joint counts, and C-reactive protein level) and disease impact factors (pain and function). RESULTS: This study included 27,768 patients. Excluding PtGA from the Boolean-based definition (3-variable remission) increased the remission rate from 5.8% to 15.8%. The rate of PtGA-near-remission varied considerably between countries, from 1.7% in India to 17.9% in Portugal. One-third of the patients in PtGA-near-remission group scored PtGA >4 of 10. Pain and function were the main correlates of PtGA, with inflammation-related variables contributing less to the model (R2 = 0.57). CONCLUSION: PtGA is moderately related to joint inflammation overall, but only weakly so in low levels of disease activity. A considerable proportion of patients otherwise in biologic remission still perceive high PtGA, putting them at risk of excessive immunosuppressive treatment.
OBJECTIVE: There is an ongoing debate about excluding patient's global assessment (PtGA) from composite and Boolean-based definitions of rheumatoid arthritis (RA) remission. This study aimed at determining the influence of PtGA on RA disease states, exploring differences across countries, and understanding the association between PtGA, measures of disease impact (symptoms), and markers of disease activity (inflammation). METHODS: Cross-sectional data from the Measurement of Efficacy of Treatment in the Era of Outcome in Rheumatology international database were used. We calculated the proportion of patients failing American College of Rheumatology/European League Against Rheumatism Boolean-based remission (4-variable remission) solely due to PtGA (PtGA-near-remission) in the overall sample and in the most representative countries (i.e., those with >3,000 patients in the database). Multivariable linear regression models were used to identify the main determinants of PtGA, grouped in predominantly inflammatory impact factors (28 tender joint counts, 28 swollen joint counts, and C-reactive protein level) and disease impact factors (pain and function). RESULTS: This study included 27,768 patients. Excluding PtGA from the Boolean-based definition (3-variable remission) increased the remission rate from 5.8% to 15.8%. The rate of PtGA-near-remission varied considerably between countries, from 1.7% in India to 17.9% in Portugal. One-third of the patients in PtGA-near-remission group scored PtGA >4 of 10. Pain and function were the main correlates of PtGA, with inflammation-related variables contributing less to the model (R2 = 0.57). CONCLUSION: PtGA is moderately related to joint inflammation overall, but only weakly so in low levels of disease activity. A considerable proportion of patients otherwise in biologic remission still perceive high PtGA, putting them at risk of excessive immunosuppressive treatment.
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: Jose Antonio Pereira da Silva; Laure Gossec; Catia Duarte; Eduardo José Ferreira Santos; Ricardo J O Ferreira; Tore K Kvien; Maxime Dougados; Maarten de Wit Journal: RMD Open Date: 2021-02
Authors: Ricardo J O Ferreira; Paco M J Welsing; Johannes W G Jacobs; Laure Gossec; Mwidimi Ndosi; Pedro M Machado; Désirée van der Heijde; José A P da Silva Journal: ACR Open Rheumatol Date: 2022-01-28
Authors: Joel Hirsh; Patrick Wood; Angela Keniston; Dennis Boyle; Itziar Quinzanos; Liron Caplan; Lisa Davis Journal: ACR Open Rheumatol Date: 2020-01-19