Background The patients with rheumatoid arthritis (RA) often do not meet patient global assessment (PGA) remission criterion despite a good clinical disease state and, therefore, PGA is not solely influenced by RA disease activity. It has been reported that PGA is a limiting factor for reaching remission.
Objectives We evaluated whether psychological state is related to Boolean-based definition of PGA remission for patients with RA.
Methods The patients with RA (n=146) were recruited. Swollen joint counts (SJC), tender joint counts (TJC), PGA and CRP were evaluated. Among patients with RA enrolled, those with good disease activity of RA (SJC≤1, TJC≤1, CRP≤1) were selected. These patients were divided into 2 groups, PGA remission group (PGA≤1cm) and PGA non-remission group (PGA>1cm). We compared psychological states between these 2 groups. Anxiety and depression were examined utilizing the Hospital Anxiety and Depression Scale-Depression (HADS-D) and -Anxiety (HADS-A), respectively. Depression was also evaluated with the Center for Epidemiologic Studies Depression Scale (CES-D). Comparison analyses were performed between PGA remission group (VAS≤1cm) and PGA non-remission group (VAS>1cm) in HADS-A, HADS-D and CES-D. Data analyses were performed utilizing Wilcoxon rank sum test.
Results The patients with RA satisfied with SJC≤1, TJC≤1 and CRP≤1 were selected (n=76). Patient characteristics of PGA remission group (n=45) and PGA non-remission group (n=31) were as follows: mean ± SD of age (53.02±1.75, 55.39±2.29 years) and duration (8.85±6.68, 8.93±7.09, years), male/female (9/39, 8/25, patients). There was no significant difference between PGA remission group and PGA non-remission group in age, sex, Steinbrocker's class and stage and disease duration (p=0.4043, p=0.7827, p=0.3936, p=0.5024 and p=0.9619, respectively). HADS-A was significantly lower in PGA remission group compared with that in PGA non-remission group (mean ± SD; 2.71±3.14, 4.32±3.57, respectively, p=0.026). HADS-D was also significantly lower in PGA remission group compared with that in PGA non-remission group (mean ± SD; 2.71±3.03, 4.77±3.87, respectively, p=0.010). Another measure of depression, CES-D, was also significantly better in PGA remission group compared with that in PGA non-remission group (mean ± SD; 9.16±6.00, 14.48±8.41, respectively, p=0.0017).
Conclusions The patients with RA who do not meet PGA remission criterion despite a good clinical disease state were in worse psychological state compared with those satisfied with Boolean-based definition of clinical remission. As PGA remission is thought to be a limiting factor for Boolean remission and PGA relates to psychological state, support for psychological state might be important to attain true remission.
Disclosure of Interest : None declared