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Patient's global assessment of disease activity and patient's assessment of general health for rheumatoid arthritis activity assessment: are they equivalent?
  1. Nasim Ahmed Khan1,
  2. Horace Jack Spencer2,
  3. Essam Ahmed Abda3,
  4. Rieke Alten4,
  5. Christof Pohl4,
  6. Codrina Ancuta5,
  7. Massimiliano Cazzato6,
  8. Pál Géher7,
  9. Laure Gossec8,
  10. Dan Henrohn9,
  11. Merete Lund Hetland10,
  12. Nevsun Inanc11,
  13. Johannes WG Jacobs12,
  14. Eduardo Kerzberg13,
  15. Maria Majdan14,
  16. Omondi Oyoo15,
  17. Ruben A Peredo-Wende16,
  18. Zahraa Ibrahim Selim17,
  19. Fotini Nikolaos Skopouli18,
  20. Alberto Sulli19,
  21. Kim Hørslev-Petersen20,
  22. Peter C Taylor21,
  23. Tuulikki Sokka22
  24. on behalf of QUEST-RA group
  1. 1Division of Rheumatology, University of Arkansas for Medical Sciences and Staff Physician, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
  2. 2Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  3. 3Department of Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt
  4. 4Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik, Teaching Hospital Charite, Berlin, Germany
  5. 5Department of Rheumatology and Rehabilitation, Gr.T.Popa University of Medicine and Pharmacy, Iasi, Romania
  6. 6Rheumatology Clinic, University of Pisa, Pisa, Italy
  7. 7Department of Rheumatology, Semmelweis University, Budapest, Hungary
  8. 8Paris Descartes University and APHP, Rheumatology B Department, Cochin Hospital, Paris, France
  9. 9Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  10. 10Department of Rheumatology RM, Copenhagen University Hospital at Glostrup, Glostrup, Denmark
  11. 11Department of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
  12. 12Department of Rheumatology and Clinical Immunology University Medical Center Utrecht, Utrecht, The Netherlands
  13. 13Department of Rheumatology, University of Buenos Aires, Buenos Aires, Argentina
  14. 14Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Lublin, Poland
  15. 15Department of Clinical Medicine and Therapeutics, School of Medicine, College of Health Sciences, Kenyatta Hospital, University of Nairobi, Nairobi, Kenya
  16. 16Division of Rheumatology, University of Michigan Health System, Ann Arbor, USA
  17. 17Department of Rheumatology and Rehabilitation, Sohage University, Sohage, Egypt
  18. 18Euroclinic Hospital of Athens and Department of Dietetics and Nutritional Science, Harokopio University, Athens, Greece
  19. 19Department of Internal Medicine, University of Genova, Genova, Italy
  20. 20Department of Rheumatology, King Christian X’s Hosiptal for Rheumatic Diseases, University of Southern Denmark, Gråsten, Denmark
  21. 21Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  22. 22 Department of Rheumatology, Arkisto/Tutkijat, Jyväskylä Central Hospital, Jyväskylä, Finland
  1. Correspondence to Dr Nasim Ahmed Khan, Division of Rheumatology, University of Arkansas for Medical Sciences, 4301 West Markham Street, # 509, Little Rock, AR 72205, USA; nakhan{at}


Objectives To assess (A) determinants of patient's global assessment of disease activity (PTGL) and patient's assessment of general health (GH) scores of rheumatoid arthritis (RA) patients; (B) whether they are equivalent as individual variables; and (C) whether they may be used interchangeably in calculating common RA activity assessment composite indices.

Methods Data of 7023 patients from 30 countries in the Quantitative Standard Monitoring of Patients with RA (QUEST-RA) was analysed. PTGL and GH determinants were assessed by mixed-effects analyses of covariance models. PTGL and GH equivalence was determined by Bland-Altman 95% limits of agreement (BALOA) and Lin's coefficient of concordance (LCC). Concordance between PTGL and GH based Disease Activity Score 28 (DAS28), Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) indices were calculated using LCC, and the level of agreement in classifying RA activity in four states (remission, low, moderate, high) using κ statistics.

Results Significant differences in relative and absolute contribution of RA and non-RA related variables in PTGL and GH ratings were noted. LCC of 0.64 and BALOA of −4.41 to 4.54 showed that PTGL and GH are not equivalent. There was excellent concordance (LCC 0.95–0.99) for PTGL and GH based DAS28, CDAI and RAPID3 indices, and >80% absolute agreement (κ statistics 0.75–0.84) in RA activity state classification for all three indices.

Conclusions PTGL and GH ratings differ in their determinants. Although they are individually not equivalent, they may be used interchangeably for calculating composite indices for RA activity assessment.

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  • Funding TS has received grants from Central Finland Health Care District (EVO-grants), the Finnish Academy and Abbott. This study was also supported, in part, by Award Number 1UL1RR029884 from the National Center For Research Resources. Funding sources did not participate in study design and the collection, management, analysis, and interpretation of data, and preparation, review, or approval of the manuscript and the decision to submit it for publication.

  • Collaborators On behalf of QUEST-RA group.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study was carried out in compliance with the Helsinki Declaration. Ethics Committees or Internal Review Boards of participating institutes approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.