Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: An analysis of 1588 patients

Ferreira RJO, Dougados M, Kirwan JR, Duarte C, De Wit M, Soubrier M, Fautrel B, Kvien TK, Da Silva JAP, Gossec L (2017)

Publication Type: Journal article

Publication year: 2017

Journal

Rheumatology Oxford University Press

Book Volume: 56

Pages Range: 1573-1578

Journal Issue: 9

DOI: 10.1093/rheumatology/kex211

Abstract

Objectives. ACR/EULAR Boolean remission in RA is frequently not obtained solely due to a patient global assessment (PGA) > 1/10 (a condition often designated as near-remission). This study aimed to assess which domains of impact could explain an elevated PGA in near-remission patients. Methods. We performed an ancillary analysis of data from three cross-sectional studies in patients with established RA. Three disease activity states were defined: remission (tender and swollen joint counts, CRP and PGA all ≤ 1), near-remission (tender and swollen joint counts, and CRP are all ≤ 1 but PGA > 1) and non-remission. Physical and psychological domains were assessed using the RA Impact of Disease 0-10 (numeric rating scale) as explanatory factors of PGA. Univariable and multivariable linear regression analyses were performed to explain PGA. Results. A total of 1588 patients (79.1% females) were analysed. The mean disease duration was 13.0 years (S.D. 9.8) and the 28-joint DAS with four variables was 3.2 (S.D. 1.4). Near-remission [mean PGA 3.6 (S.D. 1.9)] was more frequent (19.1%) than remission (12.3%). Scores of RA Impact of Disease domains were similar in near-remission and non-remission patients. In near-remission, PGA was explained (Radjusted 2 = 0.55) by pain (β = 0.29), function (β = 0.23), physical well-being (β = 0.19) and fatigue (β = 0.15). Conclusion. Near-remission was more frequent than remission. These patients, despite having no signs of significant inflammation, report an impact of disease similar to the non-remission patients. PGA in nearremission seems to be driven by physical rather than psychological domains. Selecting the best therapy for these patients requires a better understanding of the meaning of PGA, both globally and in individual patients.

Involved external institutions

Centro Hospitalar e Universitário de Coimbra (CHUC) PT Portugal (PT) University of Paris 5 - René Descartes / Université Paris V René Descartes FR France (FR) University of Bristol GB United Kingdom (GB) European League Against Rheumatism (EULAR) CH Switzerland (CH) CHU Clermont-Ferrand FR France (FR) University of Paris 6 - Pierre et Marie Curie / Université Paris VI Pierre et Marie Curie (UPMC) FR France (FR) Diakonhjemmet Hospital NO Norway (NO)

How to cite

APA:

Ferreira, R.J.O., Dougados, M., Kirwan, J.R., Duarte, C., De Wit, M., Soubrier, M.,... Gossec, L. (2017). Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: An analysis of 1588 patients. Rheumatology, 56(9), 1573-1578. https://dx.doi.org/10.1093/rheumatology/kex211

MLA:

Ferreira, Ricardo J. O., et al. "Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: An analysis of 1588 patients." Rheumatology 56.9 (2017): 1573-1578.

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