High patient global assessment scores in patients with rheumatoid arthritis otherwise in remission do not reflect subclinical inflammation

Brites, Luísa; Rovisco, João; Costa, Flávio; Freitas, João; Jesús, Diogo; Eugénio, Gisela; Serra, Sara; Duarte, Cátia; Ferreira, Ricardo J O; Silva, José António Pereira da

doi:10.1016/j.jbspin.2021.105242

Cited by 17 publications

(8 citation statements)

References 27 publications

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“…The findings support that patient reported outcomes might limit fulfilment of ACR/EULAR remission in some patients without active inflammation assessed by inflammatory markers, swollen joints and imaging 7 16 17. A recent study has proposed a modified threshold (cut-off of ≤2) for PGA in the ACR/EULAR Boolean criteria,18 and a meta-analysis shows that a Boolean-based remission definition excluding the PGA yielded similar prediction of future good radiographic outcome as the original definition 19.…”

Section: Discussionsupporting

confidence: 66%

Inflammation and biologic therapy in patients with rheumatoid arthritis achieving versus not achieving ACR/EULAR Boolean remission in a treat-to-target study

et al. 2022

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ObjectiveTo investigate limiting factors of American College of Rheumatology (ACR)/EULAR Boolean remission in rheumatoid arthritis (RA), and compare patients who fulfil the criteria to patients who only partly fulfil the criteria, with respect to imaging inflammation and biologic disease modifying anti-rheumatic drug (DMARD) usage.MethodsPatients with DMARD-naïve RA were treated according to current recommendations in the the ARCTIC trial (Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen). Limiting factors of reaching ACR/EULAR Boolean remission at 2 years were assessed. Imaging inflammation (ultrasound and MRI) in patients in remission was compared with patients failing to fulfil different components of the criteria. The OR of biologic therapy was calculated using logistic regression.ResultsOf 203 patients, 112 (55%) reached ACR/EULAR Boolean remission; 49 (24%) fulfilled three of four criteria. The main limiting factors were patient global assessment (PGA) (59%) and tender joints (22%). Imaging inflammation was not significantly different for patients in remission and patients not fulfilling the criteria due to elevated PGA and/or tender joints, but higher odds of using biologics (OR 3.63, 95% CI 1.73 to 7.61) were observed.ConclusionsPGA and tender joints were the factors most often limiting achievement of ACR/EULAR Boolean remission. The level of imaging inflammation was not elevated in these patients compared with patients in remission, but the odds of using biologic DMARDs were higher.

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Section: Discussionsupporting

confidence: 66%

Inflammation and biologic therapy in patients with rheumatoid arthritis achieving versus not achieving ACR/EULAR Boolean remission in a treat-to-target study

et al. 2022

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“…We, and in fact, some of the authors of the editorial themselves, have shown no correlation between PGA and joint damage accrual 11. We have also demonstrated that for patients who are in PGA-near-remission, there is no evidence of inflammation in other joints or synovial structures, through extensive ultrasonography assessment 12. It is difficult to envisage what room is left for the consideration in the editorial that ‘…the patient global assessment reflects components of disease activity that are otherwise not captured, …as inflammation in joints not included in a 28-joint count, such as the feet and ankles’.…”

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confidence: 67%

“…11 We have also demonstrated that for patients who are in PGA-near-remission, there is no evidence of inflammation in other joints or synovial structures, through extensive ultrasonography assessment. 12 It is difficult to envisage what room is left for the consideration in the editorial that '…the patient global assessment reflects components of disease activity that are otherwise not captured, …as inflammation in joints not included in a 28-joint count, such as the feet and ankles'. This is, therefore, not the reason 'why high patient global assessment scores, even when 28-joint counts are low, identify patients at high risk of later functional loss'.…”

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confidence: 99%

Correspondence on ‘Re-examining remission definitions in rheumatoid arthritis: considering the 28-joint Disease Activity Score, C reactive protein level and patient global assessment’

et al. 2022

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“…The PGA is a subjective measure of disease activity that has been associated with CRF, and the present study found a significant negative association with the 6MWD [ 15 ]. The PGA is more closely related to the subjective impact of RA than to objective measures such as swollen joint count and inflammation [ 14 , 33 ]. Furthermore, disease activity may affect which factors the PGA reflects.…”

Section: Discussionmentioning

confidence: 99%

Exercise Self-Efficacy and patient global assessment were associated with 6-min walk test distance in persons with rheumatoid arthritis

2022

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Introduction Low functional capacity is related to future loss of daily function and cardiovascular events. The present study explored the associations of patient-reported outcome measures (PROMs) and disease-specific measures with functional capacity as measured by the 6-min walk test (6MWT) in persons with rheumatoid arthritis (RA). Methods Seventy-nine participants from rheumatology outpatient clinics were included. The distance walked during the 6MWT (6MWD) was the dependent variable in multivariable regression analyses. Model 1 included the independent variables sex, age (in tertiles to improve model fit), and body mass index (BMI). Building on Model 1, Model 2 added smoking, patient global assessment (PGA), Exercise Self-Efficacy, Hospital Anxiety and Depression Scale’s Depression score, and Cohen’s Perceived Stress Scale score, whereas Model 3 added smoking, disease duration, present use of glucocorticosteroids, seropositivity, Disease Activity Score 28—C-Reactive Protein (DAS28-CRP), and a comorbidity variable. Results Median age was 65 years, 76% were female, and median 6MWD was 493 m. In Model 1, BMI and age were significantly associated with the 6MWD (R2 = 0.42). In Model 2, PGA and Exercise Self-Efficacy were also significantly associated with the 6MWD, with standardized regression coefficients of − 0.21 (p = 0.03) and 0.26 (p = 0.004) respectively (R2 = 0.54). The RA-specific variables in Model 3 were not significantly associated with the 6MWD (R2 = 0.49). Conclusion The PROMs PGA and Exercise Self-Efficacy were significantly associated with functional capacity as measured by the 6MWT in persons with RA, whereas disease-specific measures such as DAS28-CRP and disease duration were not. Key Points• Functional capacity measured with the 6-minute walk test was significantly associated with body mass index, age, patient global assessment, and Exercise Self-Efficacy in persons with RA.• Patient-reported outcome measures explained more of the variation in functional capacity than objective or composite measures of disease and are relevant measures in clinical follow-up.• Techniques that enhance self-efficacy for exercise should be incorporated into clinical practice to promote physical activity.

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High patient global assessment scores in patients with rheumatoid arthritis otherwise in remission do not reflect subclinical inflammation

Cited by 17 publications

References 27 publications

Inflammation and biologic therapy in patients with rheumatoid arthritis achieving versus not achieving ACR/EULAR Boolean remission in a treat-to-target study

Inflammation and biologic therapy in patients with rheumatoid arthritis achieving versus not achieving ACR/EULAR Boolean remission in a treat-to-target study

Correspondence on ‘Re-examining remission definitions in rheumatoid arthritis: considering the 28-joint Disease Activity Score, C reactive protein level and patient global assessment’

Exercise Self-Efficacy and patient global assessment were associated with 6-min walk test distance in persons with rheumatoid arthritis

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