The Patient Global Assessment of Disease Activity in Rheumatoid Arthritis: Identification of Underlying Latent Factors

Abstract

IntroductionThe patient global assessment of disease activity is a crucial component of various measures of disease activity in rheumatoid arthritis (RA). Our objective was to identify underlying latent traits driving the patient global assessment using a quantitative, multivariable data reduction approach.MethodsThis was a prospective cross-sectional study of consecutive patients with RA. The patient sample was stratified to include 50 patients with patient-provider discordance (i.e., at least 25-mm absolute difference between the patient and provider global assessments) and 20 patients with patient-provider concordance (i.e., less than 25-mm absolute difference between the patient and provider global assessments). Data were collected from the most recent rheumatology visit, including patient characteristics, current RA medications, and comorbidities. Participants completed several validated patient-reported outcome measures. The data were evaluated using factor analysis, and then linear regression was used to determine the variability in the patient global assessment explained by the factor scores.ResultsThe study included 70 patients with mean age of 61 years, 73% female, and with mean disease duration of 8 years. The means (SD) for the patient and provider global assessments were 44.6 (22.7) and 20.1 (17.7), respectively. Factor analysis yielded eight factors that represented measurements of pain, fatigue, depression or anxiety symptoms, prior diagnosis of depression or anxiety, advanced age and degenerative arthritis, inability to participate, fibromyalgia (clinical diagnosis and Widespread Pain Index), and undetermined. Linear regression analysis showed that fibromyalgia explained the greatest proportion of the variance in the patient global assessment followed by the other factors.ConclusionLatent factors underlying the patient global assessment include pain, depression and anxiety, inability to participate, fibromyalgia, advanced age, and degenerative arthritis.

Impact of COVID‐19 outbreak on rheumatic patients’ perceptions and behaviors: A cross‐sectional study

“…Disease activity perception might serve as a surrogate marker of activity when physical assessment is not feasible, especially when combined with function and pain from Routine Assessment of Patients Index 3 (RAPID3) 31 . However, patient‐reported outcomes might be influenced by factors other than their disease activity such as pre‐existing fibromyalgia and mood 32 . To examine these issues, we investigated whether diagnosis of fibromyalgia (either as a primary, secondary rheumatic disease or comorbidity) or feeling fearful of COVID‐19 might have influenced patients’ perceptions of disease activity.…”

“…The median (IQR) age was 35(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) years. The majority of the participants were female (87.3%), many of whom were Saudi (84.8%) living in central provinces including Riyadh, Qassim, and Ha'il(48.8%) and the western region (24.4%).…”

“…Analyzing individual knowledge scores was not only reflective of a patient's level of COVID-related health literacy, but also predictive to some extent regarding one's personal experience during Univariate and multivariate logistic regression output of worsening disease activity perception (dependent variable) and various outcomes (independent variable) B, coefficient; CI, confidence interval; OR, odds ratio; P, probability; SA, Saudi ArabiaSE, standard error.Disease activity perception might serve as a surrogate marker of activity when physical assessment is not feasible, especially when combined with function and pain from Routine Assessment of Patients Index 3 (RAPID3) 31. However, patient-reported outcomes might be influenced by factors other than their disease activity such as pre-existing fibromyalgia and mood 32. To examine these issues, we investigated whether diagnosis of fibromyalgia (either as a pri-Likewise, correlational evidence of this interaction coincided with needs-related factors in elderly patients with RA 40.…”

What Does the Patient Global Health Assessment in Rheumatoid Arthritis Really Tell Us? Contribution of Specific Dimensions of Health‐Related Quality of Life

“…Others have reported that pain and physical function are strongly associated with the PtGA (3,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Along with pain and function, fatigue and social participation also loaded strongly on this HRQoL dimension factor, and sleep disturbance loaded to a lesser extent.…”

“…Ferreira et al reported similar findings when assessing predictors of PtGA among 1,588 patients with RA (24). However, others have reported that anxiety and depression were significantly associated with PtGA (15,17,18,21,22,25,30,31).…”