Background Over the last decade, the use of outcome measures in daily clinical care has been endorsed by the rheumatology community and use of biologic treatment has become a part of modern rheumatology treating rheumatoid arthritis (RA), Psoriatic arthritis (PsA) and axial spondyloarthritis (ax-SpA).
Objectives Primary: to compare self reported health status in RA, PsA and ax-SpA patients followed in an ordinary Norwegian outpatient clinic. Secondary: among each disorder, to compare health status in patients using and not using biologic drugs.
Methods All patients with RA, PsA and ax-SpA were identified in the SSHF clinical computer database used for monitoring these patients. Data of the last visit in 2011 were extracted including self reported visual analogue scale (VAS, mm) for pain, fatigue, patient global, morning stiffness (hour), physical function (MHAQ, 0-3), and patient’s working and smoking status, doctor’s global assessment of disease activity and ESR. The composite score RAPID-3 (0-10) was calculated from MHAQ, pain and patient global. Proportion of patients in RAPID-3 remission (0-1) was calculated. Usual statistical methods were applied to test differences between groups.
Results Among 1153 RA, 381 PsA and 307 ax-SpA patients, the mean age was 63, 54 and 48 yrs, prevalence of women 68, 50 and 33 %, current smoking 23, 23 and 25 % and disease duration 10, 8 and 11 yrs, respectively.
A statistically significant difference (ANOVA p<0.05) between RA, PsA and ax-SpA on VAS was found for the mean back pain (32, 34 and 38 mm), back pain at night (23, 27 and 32 mm) and fatigue (39, 46 and 43 mm) and a significant difference was also found for mean MHAQ (0.51, 0.45 and 0.41) and ESR (18, 15 and 13 mm/hr). No significant differences were found for patient global assessment (36, 38 and 36 mm), doctor’s global assessment (13, 12 and 12 mm), pain (36, 37, 36 mm), joint pain (35, 36 and 34 mm), morning stiffness (1.0, 0.9 and 0.9 hr), RAPID-3 (3.0, 3.0 and 2.9) and proportion of patients in RAPID-3 remission (22.3, 19.1 and 19.3 %). A statistically significant difference between RA, PsA and ax-SpA was also found for full-time working (15, 34 and 44 %).
The proportion RA, PsA and ax-SpA patients on biologic DMARDs was 31.3%, 26.5% and 41.0% and on synthetic DMARDs 82.2%, 55.6% and 11.4%. A statistically significant difference (p<0.05) between biologic and non biologic treated patients in RA was only found for pain (33 vs 37 mm) joint pain (32 vs 37 mm) and ESR (16.7 vs 19.2 mm/hr) and in PsA only for joint pain (32 vd 38 mm) and back pain (29 vs 36 mm), whereas in ax-SpA only for ESR (10.0 vs 15.1 mm/hr).
Conclusions Our real life data show that patient and doctor’s global assessment, pain, morning stiffness and RAPID-3 is equal across the diagnosis. However PsA patients reported a higher level of fatigue and RA patients a higher MHAQ. Ax-SpA patients as expected reported more back pain than RA and PsA. Interestingly health status in biologic treated patients was on the same level as for those not on biologics. The mean RAPID-3 level across the diagnosis was in the moderate level and only approx. 20% were in RAPID-3 remission suggesting that there is still room for improvement to achieve full remission in these patients.
Disclosure of Interest None Declared
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