Background With the introduction of Treat-to-Target approach for inflammatory arthritis, adoption of patient reported outcome measures (PROMs) as part of the standard clinical practice has been emphasized by both clinicians and regulatory bodies as changes in these measures reflect changes most important to the patients.
Objectives To assess the concurrence and non-concurrence of patient and physician global assessment in Early rheumatoid arthritis (eRA) patients both in disease activity and in remission; 2. To identify the independent related variables for positive (PtGA >PhGA) and negative (PhGA>PtGA) discordance.
Methods Retrospective analysis of 480 patients diagnosed according to the 2010 ACR/EULAR criteria for eRA and included in the USACAS study . Before clinical assessment every patient completed a Patient reported outcome measures questionnaire . This includes assessment for functional disability, Quality of life; pain, PtGA and fatigue scores using 0-100 VAS, duration of morning stiffness, self-reported joint tenderness and helplessness as well as systemic affection. The treating physician reviewed the patients answers, before clinical assessment and calculation of disease activity score (DAS-28). Non-concurrence was defined as a difference of 20% (2 or more units) on the VAS between the physician and patient global scores. The patients were stratified into 3 categories: patients with similar (within 20/100 units) scores (PtGA = PhGA); patients with PtGA >20 units or more higher than PhGA (PtGA > PhGA); and those with PhGA >20 or more units higher than PtGA (PhGA > PtGA). Bivariate analysis was carried out as well as multinominal logistic regression analysis.
Results In patients with Moderate- highly active disease (DAS-28 >3.2), mean PtGA was 8.6 whereas mean PhGA was 6.7 (P<0.05). Analysis of the scores revealed, PtGA > PhGA in 56% of the patients, PtGA = PhGA in 31% whereas PhGA > PtGA was reported in 13% of the patients. On the other hand, in patients with low disease activity (DAS-28 <3.2) or in remission (DAS-28 <2.6), mean PtGA was 2.3 and mean PhGA was 1.9. Analysis of the scores revealed, PtGA > PhGA 12%, PtGA = PhGA in 79%, PhGA > PtGA in 9%. PtGA > PhGA was associated significantly with scores of DAS-28, pain, fatigue, quality of life, functional disability, duration of morning stiffness, patient self-reported joint tenderness, systemic manifestations, work ability and self-helplessness. PhGA > PtGA was associated with DAS-28, physician reported joint tenderness, swollen joint count, functional disability, ESR and CRP levels. There was no correlation with age, sex, level of education or marital status.
Conclusions Global estimates of both patients and physicians vary according to disease activity status. Parameters such as sleep, fatigue, self-helplessness and work ability have a significant impact on the patients with active disease and should be considered by the treating physician. Whilst HAQ assess the patients' functional ability, quality of life assessment should be also added to the standard clinical assessment.
US guided treat to target approach in early RA. Arthritis Rheum 2013; 65(10): S966
Incorporating patient reported outcome measures in clinical practice. Clin Exp Rheumatol. 2010; 28(5):734.
Disclosure of Interest None declared