Background Patient global assessment (PtGA) is included in all the current remission definitions for RA despite the fact that PtGA is not exclusively related to disease activity.
Objectives In this study in order to objectively identify whether patient's assessment is better than physician's (Ph) or not, we compared disease activities assessed with ultrasound (US) of Boolean remission patients with PtGA and with PhGA.
Methods RA patients in clinical remission (DAS28 ESR<2.6) for at least 3 months were included. Boolean based remission definition and modified version by substitution of PtGA with PhGA were determined. A standard gray scale (GS) and power Doppler (PD) US examination of 28 joints (included in DAS28) for the presence of synovitis was performed by an experienced sonographer (NI) blinded to clinical data. US synovitis GS and PD signals were semiquantitatively graded from 0 to 3 and were recorded as sum scores of PD and GS, respectively.
Results A total of 88 out of 389 RA patients (22.6%) in DAS28 remission were enrolled (F/M=55/33, mean age 53.4±12.0, disease duration 10.5±6.3 years, bDMARDs 44.3%, RF/Anti-CCP positivity 72%). Of 88 patients, 33 (37.5%) fulfilled the Boolean remission criteria. When PtGA was substituted with PhGA, Boolean remission rate increased to 61.4% (n=54) (P<0.001). Regarding US disease activity no PD, no GS and no PD+GS signals were observed in 13 (39.4%) vs 16 (29.6%), 10 (30.3%) vs 11 (20.4%) and 9 (27.3%) vs 10 (18.5%) patients in Boolean remission with PtGA and PhGA, respectively (Table 1). When PD and GS signals > grade 1 were taken into account, % of patients without PD, GS or both signals were also similar Table 1). US disease activity parameters of Boolean PtGA and Boolean PhGA remission and their counterpart nonremission patients were compared as well, Boolean remission either with PtGA or PhGA had significantly lower PD scores compared to Boolean nonremission groups with PtGA or PhGA (1 [0–4] vs 3 [1–7], P=0.016 and 1.5 [0–4] vs 4 [0.75–7], P=0.027, respectively).
Conclusions RA patients in Boolean remission with PhGA do not have higher disease activity that is verified by US, compared to patients in Boolean remission with PtGA. Furthermore Boolean remission with PhGA differentiates patients with US evinced inflammation, especially PD scores, as good as PtGA. These data suggest that PtGA might be substituted with PhGA in Boolean criteria with higher remission achievement rates. Prospective follow up and recruitment of more patients will clarify the consistency of these results over time and impact of this substitution on functionality.
Disclosure of Interest None declared