Objectives Assessment of the relationship between US measures of joint inflammation/damage and patient reported outcomes (PROs): HAQ, pain and patient global assessment in early rheumatoid arthritis (early RA) patients over 5-years follow up period.
Methods This longitudinal cohort of 261 patients with early RA was derived from the US monitoring study . Adopting OMERACT definitions; correlations between total US scores (synovial hypertrophy, synovial fluid, Power Doppler, bone erosion and tenosynovitis) and PROs  namely functional disability (HAQ), pain and patient global scores were determined at 0, 1, and 5years. Radiological damage was assessed using modified Total Sharp score (mTSS). Univariate correlations as well as correlations between interval changes were assessed. Multivariable regression models were used to evaluate the associations over all time-points and their relationship to clinical disease activity measures.
Results There were significant correlations (p<0.01) between total US score and HAQ (r=0.71), pain (r=0.69) and patient global scores (r=0.66) at all timepoints. The association tends to be stronger with increase disease duration (Spearman correlation 0.12 at baseline, 0.22 at 1-year and 0.41 at 5-years). Change in mTSS score at 5-years was not associated with changes in PROs. Improvements in US scores were also associated with improvements in PROs. Multivariate models revealed that synovial hypertrophy and Power Doppler scores were associated (p<0.01) with functional disability, pain and patient global assessment, controlling for clinical disease activity measures. Studying the pattern of joint involvement, it was associated significantly (p<0.01) with the US score of the affected joints. US total score at 1-year predicted subsequent 5-year HAQ score (R2=0.17). At 0, 1- and 5-years, total US scores were higher in patients whose HAQ score was >1 (9.26) compared to those below 1 (4.16, p<0.01).
Conclusions the link between joint inflammation/structural damage and PROs is of critical importance to the care of patients with inflammatory arthritis. US measures of inflammation and structural damage correlated independently with physical function, pain and patient global assessments. A clear relationship between radiographic structure damage and the patient's perceived remission/flare provide the basis for comprehensive disease assessment and management.
El Miedany et al. Current Rheumatology Reviews 2015; 11, 18–27.
El Miedany et al. Clin Exp Rheumatol 2010; 28(5):734–44.
Disclosure of Interest None declared
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