Baseline patient reported outcomes are more consistent predictors of long-term functional disability than laboratory, imaging or joint count data in patients with early inflammatory arthritis: A systematic review

Gwinnutt, James M; Sharp, Charlotte A; Symmons, Deborah; Verstappen, Suzanne

doi:10.1016/j.semarthrit.2018.03.004

Cited by 16 publications

(14 citation statements)

References 57 publications

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“…The fact that active inflammation does not seem to be a major predictor of future pain is compatible with several studies demonstrating a discrepancy between pain and disease activity (2,3,27). The present data agree with these findings and suggest that this may be explained by a multifactorial origin of pain in RA.…”

Section: Discussionsupporting

confidence: 92%

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Unacceptable pain in the BARFOT inception cohort of patients with rheumatoid arthritis: a long-term study

Svensson

Forslind

Andersson

2020

Scandinavian Journal of Rheumatology

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Objectives: Pain is the most common and troublesome complaint in rheumatoid arthritis (RA). This study aimed to assess the prevalence and clinical implications of unacceptable pain in an inception cohort of patients with RA. Method: This study followed 477 patients from the BARFOT (Better Anti-Rheumatic FarmacOTherapy) early RA cohort for 15 years. Unacceptable pain was defined as ≥ 40 mm on a visual analogue scale for pain, while tolerable pain denoted no pain or pain below this cut-off, according to the patient acceptable symptom state concept. Results: Unacceptable pain was frequent. At the 15 year follow-up visit, 34% had unacceptable pain. Patients with unacceptable pain had, compared with patients with tolerable pain, significantly more disease activity, worse patient global assessment, and worse function on the Health Assessment Questionnaire and Signals of Functional Impairment, but the degree of joint destruction was similar. Disease-modifying anti-rheumatic drug treatment was similar, but patients with unacceptable pain were more often treated with corticosteroids. At 15 years, patients with unacceptable pain who were in remission (33%) had less inflammation and better function than those not in remission, suggesting the presence of non-inflammatory causes of pain. Conclusions: In this cohort of patients with RA, pain was frequent and severe, with negative effects on experienced health and function. Unacceptable pain was frequent and occurred also in patients in remission, indicating that pain in RA is multifactorial and should always be regarded as an important concern in itself. The cause of pain should be recognized and treated appropriately.

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Section: Discussionsupporting

confidence: 92%

“…This opinion is also supported by the fact that pain in the present study strongly correlated with PatGA at 15 years (r = 0.87). Pain has been reported to predict functional capacity (27). Indeed, pain in RA has been said to be 'a more important cause of disability than structural joint damage' (26).…”

Section: Discussionmentioning

confidence: 99%

Unacceptable pain in the BARFOT inception cohort of patients with rheumatoid arthritis: a long-term study

Svensson

Forslind

Andersson

2020

Scandinavian Journal of Rheumatology

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“…As PROMs (e.g. pain, fatigue, mental health) are the most consistent predictors of long-term function [ 47 ], we investigated the relationship between these PROMs and disability, both when measured at baseline and longitudinally. Baseline and time-varying pain, fatigue and mental health were all associated with high HAQ trajectory membership.…”

Section: Discussionmentioning

confidence: 99%

Exploring the disparity between inflammation and disability in the 10-year outcomes of people with rheumatoid arthritis

et al. 2022

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Objectives To identify groups of people with rheumatoid arthritis (RA) with different disability trajectories over ten years, despite comparable levels of inflammation. Methods Data for this analysis came from three European prospective cohort studies of people with RA (Norfolk Arthritis Register [NOAR], Early Rheumatoid Arthritis Network [ERAN], Étude et Suivi des Polyarthrites Indifférenciées Récentes [ESPOIR]). Participants were assessed regularly over 8 (ERAN) to 10 (NOAR/ESPOIR) years. Inclusion criteria were: recruited after 1/1/2000, <24 months baseline symptom duration, and disability (Health Assessment Questionnaire [HAQ]) and inflammation (two-component disease activity score [DAS28-2C]) recorded at baseline and one other follow-up. People in each cohort also completed patient reported outcome measures at each assessment (pain, fatigue, depressive symptoms). Group-based trajectory models (GBTM) were used to identify distinct groups of people with similar HAQ and DAS28-2C trajectories over follow-up. Results This analysis included 2500 people with RA (NOAR: 1000, ESPOIR: 766, ERAN: 734). ESPOIR included more women and participants were younger (mean [standard deviation] age: NOAR: 57.1 [14.6], ESPOIR: 47.6 [12.5], ERAN: 56.8 [13.8]; women: NOAR: 63.9%, ESPOIR: 76.9%, ERAN: 69.1%). Within each cohort, two pairs of trajectories following the hypothesised pattern (comparable DAS28-2C but different HAQ) were identified. Higher pain, fatigue and depressive symptoms were associated with increased odds of being in the high HAQ trajectories. Conclusion Excess disability is persistent in RA. Controlling inflammation may not be sufficient to alleviate disability in all people with RA, and effective pain, fatigue and mood management may be needed in some groups to improve long-term function.

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“…This is not related to radiologic progression, but to disease activity and disease burden, which is easier to re-balance the sooner it is targeted [ 39 , 40 ]. Ideally rheumatologists would like to start the most effective treatment for patients within their window of opportunity to prevent refractory disease [ 41 ] One of the best predictors of insufficient long-term outcomes, like functional disability, but also ongoing disease activity, are high scores in the Health Assessment Questionnaire (HAQ) [ 42 , 43 ]. Seropositive patients had numerically lower HAQ scores [ 37 ] and were more likely to achieve remission using the ACR/EULAR Boolean remission definition [ 38 ].…”

Section: Ra Guidelines: Diagnostic Versus Classification Criteria - the Clinician's Perspectivementioning

confidence: 99%

Impact of autoimmune serology test results on RA classification and diagnosis

Hoovels

Studenic

Sieghart

et al. 2022

Journal of Translational Autoimmunity

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Rheumatoid arthritis (RA) is the most common systemic autoimmune disease and also the most severe arthritic disorder. The measurement of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) in serum supports the diagnosis of RA, which gained increasing significance over the last 65 years. However, a high variability between RF and ACPA methods has been described, impacting the diagnostic performance of the current ACR/EULAR RA classification criteria. The great number of commercially available assays, often lacking traceability to an international standard, is a major factor attributing to this in-between assay variability. The adoption of an international standard for ACPA, as is since long available for rheumatoid factor, is therefore highly desirable. Further harmonization in clinical interpretation of RF/ACPA assays could be obtained by harmonization of the cut-offs, for both the low and high antibody levels, based on predefined specificity in disease controls. Reporting test result specific likelihood ratios (LR) adds value in the interpretation of autoantibody tests. However, a good understanding of the control population used to define antibody test result interval-associated LRs is crucial in defining the diagnostic performance characteristics of antibody serology. Finally, specificity in RA classification can be improved by refining serological weight scoring taking into account the nature of the antibody, the antibody level and double RF + ACPA positivity.

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Baseline patient reported outcomes are more consistent predictors of long-term functional disability than laboratory, imaging or joint count data in patients with early inflammatory arthritis: A systematic review

Abstract: Baseline age, gender, HAQ and pain scores are associated with long-term disability and knowledge of these may aid the assessment of prognosis.

Cited by 16 publications

References 57 publications

Unacceptable pain in the BARFOT inception cohort of patients with rheumatoid arthritis: a long-term study

Unacceptable pain in the BARFOT inception cohort of patients with rheumatoid arthritis: a long-term study

Exploring the disparity between inflammation and disability in the 10-year outcomes of people with rheumatoid arthritis

Impact of autoimmune serology test results on RA classification and diagnosis

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