Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: an analysis of 1588 patients

Ricardo J O Ferreira; Maxime Dougados; John R Kirwan; Cátia Duarte; Maarten de Wit; Martin Soubrier; Bruno Fautrel; Tore K Kvien; José A P da Silva; Laure Gossec; CoimbRA investigators, RAID investigators and COMEDRA investigators

doi:10.1093/rheumatology/kex211

Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: an analysis of 1588 patients

Ricardo J O Ferreira, Maxime Dougados, John R Kirwan, Cátia Duarte, Maarten de Wit, Martin Soubrier, Bruno Fautrel, Tore K Kvien, José A P da Silva, Laure Gossec, CoimbRA investigators, RAID investigators and COMEDRA investigators

Research output: Contribution to journal › Article (Academic Journal) › peer-review

76 Citations (Scopus)

492 Downloads (Pure)

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.

Original language	English
Pages (from-to)	1573-1578
Number of pages	6
Journal	Rheumatology
Volume	56
Issue number	9
Early online date	30 Jun 2017
DOIs	https://doi.org/10.1093/rheumatology/kex211
Publication status	Published - 1 Sept 2017

Keywords

Adaptation, Psychological
Adult
Aged
Arthritis, Rheumatoid
Biomarkers
C-Reactive Protein
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Patient Reported Outcome Measures
Remission Induction
Severity of Illness Index
Stress, Psychological
Journal Article
Observational Study

Access to Document

10.1093/rheumatology/kex211

Full-text PDF (accepted author manuscript)
This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Oxford Academic at https://academic.oup.com/rheumatology/article/56/9/1573/3867425 . Please refer to any applicable terms of use of the publisher.
Accepted author manuscript, 355 KB
Supplementary information PDFAccepted author manuscript, 672 KB

Handle.net

Persistent link

Cite this

Ferreira, R. J. O., Dougados, M., Kirwan, J. R., Duarte, C., de Wit, M., Soubrier, M., Fautrel, B., Kvien, T. K., da Silva, J. A. P., Gossec, L., & CoimbRA investigators, RAID investigators and COMEDRA investigators (2017). Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: an analysis of 1588 patients. Rheumatology, 56(9), 1573-1578. https://doi.org/10.1093/rheumatology/kex211

@article{6e525aafb9d94f3d8eff41ae51109baa,

title = "Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: an analysis of 1588 patients",

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.",

keywords = "Adaptation, Psychological, Adult, Aged, Arthritis, Rheumatoid, Biomarkers, C-Reactive Protein, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Patient Reported Outcome Measures, Remission Induction, Severity of Illness Index, Stress, Psychological, Journal Article, Observational Study",

author = "Ferreira, {Ricardo J O} and Maxime Dougados and Kirwan, {John R} and C{\'a}tia Duarte and {de Wit}, Maarten and Martin Soubrier and Bruno Fautrel and Kvien, {Tore K} and {da Silva}, {Jos{\'e} A P} and Laure Gossec and {CoimbRA investigators, RAID investigators and COMEDRA investigators}",

year = "2017",

month = sep,

day = "1",

doi = "10.1093/rheumatology/kex211",

language = "English",

volume = "56",

pages = "1573--1578",

journal = "Rheumatology",

issn = "1462-0324",

publisher = "Oxford University Press",

number = "9",

}

Ferreira, RJO, Dougados, M, Kirwan, JR, Duarte, C, de Wit, M, Soubrier, M, Fautrel, B, Kvien, TK, da Silva, JAP, Gossec, L & CoimbRA investigators, RAID investigators and COMEDRA investigators 2017, 'Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: an analysis of 1588 patients', Rheumatology, vol. 56, no. 9, pp. 1573-1578. https://doi.org/10.1093/rheumatology/kex211

TY - JOUR

T1 - Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission

T2 - an analysis of 1588 patients

AU - Ferreira, Ricardo J O

AU - Dougados, Maxime

AU - Kirwan, John R

AU - Duarte, Cátia

AU - de Wit, Maarten

AU - Soubrier, Martin

AU - Fautrel, Bruno

AU - Kvien, Tore K

AU - da Silva, José A P

AU - Gossec, Laure

AU - CoimbRA investigators, RAID investigators and COMEDRA investigators

PY - 2017/9/1

Y1 - 2017/9/1

N2 - 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.

AB - 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.

KW - Adaptation, Psychological

KW - Adult

KW - Aged

KW - Arthritis, Rheumatoid

KW - Biomarkers

KW - C-Reactive Protein

KW - Cross-Sectional Studies

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Patient Reported Outcome Measures

KW - Remission Induction

KW - Severity of Illness Index

KW - Stress, Psychological

KW - Journal Article

KW - Observational Study

U2 - 10.1093/rheumatology/kex211

DO - 10.1093/rheumatology/kex211

M3 - Article (Academic Journal)

C2 - 28859325

SN - 1462-0324

VL - 56

SP - 1573

EP - 1578

JO - Rheumatology

JF - Rheumatology

IS - 9

ER -

Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: an analysis of 1588 patients

Abstract

Keywords

Access to Document

Handle.net

Fingerprint

Cite this