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THU0580-HPR Psychological Remission May BE Effective to Attain Remission of Boolean-Based Definition of Patient Global Assessment in Patients with Rheumatoid Arthritis
  1. M. Fusama1,2,
  2. K. Yukioka3,
  3. T. Kuroiwa4,
  4. C. Yukioka5,
  5. M. Inoue3,
  6. T. Nakanishi3,
  7. N. Murata5,
  8. N. Takai3,
  9. K. Higashi1,
  10. Y. Miura2,
  11. T. Kuritani6,
  12. K. Maeda6,
  13. H. Sano7,
  14. M. Yukioka5,
  15. H. Nakahara6
  1. 1Division of Nursing, NTT West Osaka Hospital, Osaka
  2. 2Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe
  3. 3Division of Clinical Psychology
  4. 4Department of Rheumatology
  5. 5Department of Orthopaedic Surgery, Yukioka Hospital
  6. 6Allergy, Rheumatology and Connective Tissue Diseases, Department of Internal Medicine, NTT West Osaka Hospital, Osaka
  7. 7Division of Rheumatology of internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan

Abstract

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

DOI 10.1136/annrheumdis-2014-eular.2438

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