Patient global assessment in measuring disease activity in rheumatoid arthritis: a review of the literature

Abstract

Patient-reported outcomes (PROs) reflect the patient’s perspective and are used in rheumatoid arthritis (RA) routine clinical practice. Patient global assessment (PGA) is one of the most widely used PROs in RA practice and research and is included in several composite scores such as the 28-joint Disease Activity Score (DAS28). PGA is often assessed by a single question with a 0–10 or 0–100 response. The content can vary and relates either to global health (e.g., how is your health overall) or to disease activity (e.g., how active is your arthritis). The wordings used as anchors, i.e., for the score of 0, 10, or 100 according to the scale used, and the timing (i.e., this day or this week) also vary. The different possible ways of measuring PGA translate into variations in its interpretation and reporting and may impact on measures of disease activity and consequently achievement of treat-to-target goals. Furthermore, although PGA is associated with objective measures of disease activity, it is also associated with other aspects of health, such as psychological distress or comorbidities, which leads to situations of discordance between objective RA assessments and PGA. Focusing on the role of PGA, its use and interpretation in RA, this review explores its validity and correlations with other disease measures and its overall value for research and routine clinical practice.

Automated Text Message–Enhanced Monitoring Versus Routine Monitoring in Early Rheumatoid Arthritis: A Randomized Trial

“…Previous studies have shown that PtGA is a reliable measure on a group level that is sensitive to change and has a good test-retest reliability (15)(16)(17). However, individual-level factors like pain can influence PtGA significantly (6).…”

Determinants of Patient’s Global Assessment of Disease Activity and Physician’s Global Assessment of Disease Activity in patients with rheumatoid arthritis: A post hoc analysis of overall and Japanese results from phase 3 clinical trials

“…First, the analysis included data obtained from two large-scale, randomized controlled trials, ensuring that all evaluations were performed in a consistent manner compared with observational studies. Second, we used identical and current-arthritis-disease-activity-focused questions for patients and physicians that helped to avoid issues related to interpretation, which can arise from inconsistencies in wording/phrasing [21]. Third, the analysis included a large number of candidate variables.…”

Assessing Rheumatoid Arthritis Disease Activity With Patient‐Reported Outcomes Measurement Information System Measures Using Digital Technology

“…To assess pain intensity, patients are required to answer the question, “How much pain have you had because of your condition OVER THE PAST WEEK?” The pain NRS is a unidimensional measure of pain intensity and has been widely used among patients with RA; it is typically operationalized as a single‐item scale ranging from 0 to 10 and completed by the patient . For the patient global assessment, patients are required to answer the single question “Considering all the ways in which illness and health conditions may affect you at this time, please indicate below how you are doing” .…”