High Adherence to System‐Level Performance Measures for Rheumatoid Arthritis in a National Early Arthritis Cohort Over Eight Years

Barber, Claire; Schieir, Orit; Lacaille, Diane; Marshall, Deborah A.; Barnabe, Cheryl; Hazlewood, Glen; Thorne, John; Ahluwalia, Vandana; Bartlett, Susan J.; Boire, Gilles; Hitchon, Carol; Keystone, Edward; Tin, D.; Pope, Janet; Denning, Lisa; Bykerk, Vivian P.

doi:10.1002/acr.23439

Cited by 11 publications

(15 citation statements)

References 22 publications

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“…The Canadian Early Arthritis Cohort (CATCH) allows us to extract high-quality data since patients are followed up regularly over time, with multiple disease variables being collected. The performance of the CATCH cohort has recently been assessed, and the cohort has shown high rates of yearly follow-up, DMARD use, and treatment with DMARDs within 2 weeks of diagnosis (10). Using this incident early arthritis cohort, we aimed to determine if the level of fatigue at baseline and at 3 months could be predictive of patient outcomes at 1 year, if early control of disease activity would result in sustained reductions in fatigue well beyond 1 year, and if improvement in fatigue could be attained in those who achieved sustained disease remission within the first year, and if so, whether the maximum improvement in fatigue lagged behind the iniital achievement of remission.…”

Section: Introductionmentioning

confidence: 99%

Improvements in Fatigue Lag Behind Disease Remission in Early Rheumatoid Arthritis: Results From the Canadian Early Arthritis Cohort

Holdren

Schieir

Bartlett

et al. 2020

Arthritis & Rheumatology

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Objective. To examine the relationship between disease activity and fatigue over time in early rheumatoid arthritis (RA). Methods. Data were from patients with early RA (duration of symptoms ≤12 months) enrolled in the Canadian Early Arthritis Cohort (CATCH). Patients rated the level of their fatigue over the past week using an 11-point numerical rating scale for up to 5 years of follow-up. Fatigue severity was classified as low (≤2), moderate (>2 but <5), or high (≥5). Fatigue severity ratings in patients who achieved a low disease activity state (Disease Activity Score in 28 joints [DAS28] ≤3.2) were compared to those in patients who did not achieve a low disease activity state within 3 months of cohort entry. Results. Of 1,864 patients included, 88% met RA criteria, and 72% were women. The mean ± SD baseline DAS28 was 4.9 ± 1.5. Nineteen percent of the patients reported moderate baseline fatigue, and 59% reported severe baseline fatigue. Fatigue was correlated with pain and patient global disease activity ratings (r = 0.56-0.67, P < 0.001), and was weakly correlated with the DAS28, tender joint count, swollen joint count, physician global assessment of disease activity, erythrocyte sedimentation rate, and C-reactive protein level. Patients who reported low fatigue by 3 months had significantly lower fatigue throughout follow-up compared to those who had moderate or high fatigue at 3 months (P < 0.001). Patients who achieved a DAS28 ≤3.2 within 3 months had significantly lower fatigue ratings than those with a DAS28 >3.2 (mean ± SD fatigue severity score 2.7 ± 2.6 versus 4.6 ± 3.0; P < 0.001), with improvements in fatigue that persisted through 5 years of follow-up. Maximal improvements in fatigue lagged behind remission by 6 months. Conclusion. Fatigue is common in early RA, and improvements may occur after remission. Early treatment response within 3 months after treatment initiation was associated with short-term and long-term improvements in fatigue over time.

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Section: Introductionmentioning

confidence: 99%

Improvements in Fatigue Lag Behind Disease Remission in Early Rheumatoid Arthritis: Results From the Canadian Early Arthritis Cohort

Holdren

Schieir

Bartlett

et al. 2020

Arthritis & Rheumatology

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“…Nowadays, the synovial hyperplasia could be easily observed by grayscale ultrasound (GSUS), and the pathogenic vascularization could be evaluated by color Doppler ultrasound (CDUS) (5). Some studies have reported that synovial inflammation is still detected in patients with RA in clinical remission (6)(7)(8), which is called subclinical synovitis. RA patients with disease in remission are more likely to recur if the subclinical synovitis exists (9).…”

Section: Introductionmentioning

confidence: 99%

Role of 7-Joint Ultrasonic Score in Predicting the Prognosis of Rheumatoid Arthritis

Zou

Guo

et al. 2020

Iran J Radiol

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Background: There is a higher possibility for rheumatoid arthritis (RA) recurrence if patients have subclinical synovitis. Seven-joint ultrasonic score (US7 score) allows an accurate detection of subclinical synovitis, but its predictive role in the recurrence of RA patients in remission is uncertain. Objectives: The goal of this study was to explore the role of US7 score in predicting the recurrence of RA patients with disease in clinical remission. Patients and Methods: Totally, 186 RA patients in clinical remission were recruited and their demographic and clinicobiologic characteristics were collected. The US7 score and disease activity score in 28 joints (DAS28) were recorded as baseline indicators for a 1-year follow-up. Patients were divided into the recurrence group and non-recurrence group according to their recurrent results. The clinical indicators and US7 scores before the follow-up were compared and analyzed between the two groups. Kaplan-Meier and univariate COX regression analysis were used to analyze the effect of US7 score on the recurrence of RA. Receiver-operating characteristics (ROC) curves were established to evaluate the predictive accuracy of DAS 28 and US7 score for the outcome of RA. Results: Of the 186 RA patients, 55.9% received conventional disease-modifying antirheumatic drugs (cDMARDs) and 44.1% received biologic disease-modifying antirheumatic drugs (bDMARDs). Totally, 60 patients (32.3%) suffered from recurrence and were included in the recurrence group, and the remaining 126 patients were included in the non-recurrence group. The recurrence rate of patients without subclinical synovitis (10.26%) was lower than that of patients with subclinical synovitis (48.15%, χ2 = 27.556, P < 0.001). US7 score was associated with an increased risk of recurrence in RA patients after successful treatment (P < 0.001, hazard ratio = 1.363, 95% CI = 1.247 - 1.488). The area under the curve of the prediction model with combined US7 score and DAS 28 was higher (0.904) compared to that of US7 score or DAS 28 (P < 0.05). Conclusion: The US7 score is capable of predicting the recurrence of RA patients because of its advantages in identifying subclinical synovitis. The combined model of DAS28 and US7 score was accurate for predicting the recurrence of RA patients in clinical remission.

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“…This work builds upon previous national efforts to develop a measurement framework for monitoring and improving care for patients with inflammatory arthritis that was developed in collaboration with the AAC [15]. The AAC System-Level Performance Measure set included 6 measures that have been used to evaluate early access to care and treatment for [24][25][26][27][28]. All 3 of the measures previously included in the AAC measurement set (wait times for JIA care, percentage of patients seen within 1 year of diagnosis, and percentage of patients seen in yearly follow-up) were retained in the current measurement set.…”

Section: Discussionmentioning

confidence: 99%

A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care

et al. 2020

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Background:The evaluation of quality of care in juvenile idiopathic arthritis (JIA) is critical for advancing patient outcomes but is not currently part of routine care across all centers in Canada. The study objective is to review the current landscape of JIA quality measures and use expert panel consensus to define key performance indicators (KPIs) that are important and feasible to collect for routine monitoring in JIA care in Canada. Methods: Thirty-seven candidate KPIs identified from a systematic review were reviewed for inclusion by a working group including 3 pediatric rheumatologists. A shortlist of 14 KPIs was then assessed using a 3-round modified Delphi panel based on the RAND/UCLA Appropriateness Method. Ten panelists across Canada participated based on their expertise in JIA, quality measurement, or lived experience as a parent of a child with JIA. During rounds 1 and 3, panelists rated each KPI on a 1-9 Likert scale on themes of importance, feasibility, and priority. In round 2, panelists participated in a moderated in-person discussion that resulted in minor modifications to some KPIs. KPIs with median scores of ≥ 7 on all 3 questions without disagreement were included in the framework.

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High Adherence to System‐Level Performance Measures for Rheumatoid Arthritis in a National Early Arthritis Cohort Over Eight Years

Cited by 11 publications

References 22 publications

Improvements in Fatigue Lag Behind Disease Remission in Early Rheumatoid Arthritis: Results From the Canadian Early Arthritis Cohort

Improvements in Fatigue Lag Behind Disease Remission in Early Rheumatoid Arthritis: Results From the Canadian Early Arthritis Cohort

Role of 7-Joint Ultrasonic Score in Predicting the Prognosis of Rheumatoid Arthritis

A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care

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