Background The evaluation of the activity of rheumatoid arthritis (RA) is essential in order to adapt the treatment. But, what is in real life the patient’s opinion on activity of his disease?
Methods The present study, single-center, cross-sectional, has included RA meeting ACR 1987 or EULAR 2010 criteria. The main of this study was to assess the correlation between physician composite index (DAS VS, DAS CRP, SDAI and CDAI) and the perceived level of disease activity by the patient himself. The secondary goal was to identify doctor/patient discrepancy factors. To do this, each patient completed a Beck evaluation form (to detect depression) and a HAQ evaluation form.
Results This study included 162 patients, 56 years old (+/-13 years) on average, with 78% of women, followed in day hospital (48%) or in out-visit (52%), with a disease duration of 17 years (+/- 11). Rheumatoid factor was present among 85% of patients, anti CCPamong 81% of them and erosive disease among 80% of them.
The average index were: 3.06 (+/-1.37) for DAS VS, 2.93 (+/-1.12) for DAS CRP; CDAI 10.8 (+/-9.6) and SDAI 17.6 (+/-15.4). Moderate activity level had the largest number of patients (31-37% depending on the index).
Patients felt in remission (9%), in low activity (27%), in moderate activity (51%) and high activity (13%).
Match was assessed by weighted kappa (k), with a poor doctor/patient correlation with DAS CRP (k = 0.21), SDAI (k = 0.38), CDAI (k = 0.39) and even worse with the DAS VS (k = 0.18). There were 64% of mismatch with the DAS VS. Univariate analysis showed that VAS pain and ESRwere significant mismatch factors, as well as treatments: abatacept and tocilizumab. The pain in the feet / forefeet, underlying depression and HAQ were not significant mismatch factors (p> 0.2). Other variables included in the multivariate analysis models (0.05 <p <0.2) were VASactivity, painful and swollen joint count, the taking of corticotherapy, adalimumab and rituximab. Significant variables in multivariate were: adalimumab, abatacept, tocilizumab, inflammatory syndrome with ESR> 20 mm VAS pain.
Conclusions Doctor/patient match on the appraisal of disease activity is bad or poor, with 64% of mismatch VAS pain and VS are significant mismatch factors.
Disclosure of Interest None Declared