Use of rheumatoid arthritis impact of disease (RAID) in routine care; identification of DAS28 remission and unmet patient-reported outcomes

Abstract

Objective The aim was to assess how the patient-reported outcome RA impact of disease (RAID) relates to DAS28 categories in routine care, its utility in identifying patients in DAS28 remission (RDAS) or low disease activity (LDAS) and the burden of unmet patient-reported needs in those achieving RDAS/LDAS. Methods DAS28 and RAID scores were collected from patients with established RA attending for routine review. The relationship between RAID and DAS28 was assessed with univariate pairwise correlation and mixed-effects linear regression analyses. RAID <2 was defined as a patient-acceptable state. Results One hundred and ninety-eight patients were assessed, with 220 observations, using DAS28-CRP categories: 47.5% RDAS, 14.1% LDAS, 31.8% moderate DAS (MDAS) and 6.6% high DAS (HDAS). Both patient visual analog scale score and tender joint count exhibited a high statistical association with RAID using linear regression (P < 0.0001). The mean RAID score per DAS28-CRP category was RDAS 1.84, LDAS 4.78, MDAS 5.60 and HDAS 7.68, with a statistically significant increase in RAID per unit increase in DAS-CRP or DAS28-ESR on linear regression (P < 0.001). Of 66 patients with RAID <2, 64 (97%) were in RDAS and 65 (98.5%) in RDAS/LDAS. Of 134 patients in RDAS/LDAS, RAID was ≥2 in 69 (51.5%), with fatigue and sleep being the worst-scoring domains. Conclusion RAID functions well as a patient-reported outcome in routine care. Patients with RAID <2 have a high likelihood of being in RDAS/LDAS and, if pre-screened, could avoid a clinic visit. Analysis of RAID domains provides individualized targets for holistic care in RA management, with fatigue and sleep problems dominating unmet needs in those in RDAS/LDAS.

Adopting PROs in virtual and outpatient management of RA

“…The RAID scores correlated strongly with the DAS28 when calculated with the erythrocyte sedimentation rate (DAS28-ESR) or the C-reactive protein concentration (DAS28-CRP) and also correlated with the patient global assessment (PGA) component of the DAS28 composite score 1 . Notably, the PGA covers two concepts -global health and overall disease activity -and is the PRO incorporated into most of the ACR-endorsed and EULARendorsed RA assessment tools.…”

“…explored using mixed-effects linear regression. Mistry et al 1 found that both the patient global visual analogue scale and the square root tender joint count were strongly associated with RAID scores (P < 0.01). Importantly, of the 66 patients with a RAID score <2, 92-97% met remission criteria, and 98.5% were in remission or low disease activity according to DAS28-ESR or DAS28-CRP thresholds.…”

“…However, judging which patients might be most suited to a remote consultation is not a straightforward matter. Findings from a new study suggest that the Rheumatoid Arthritis Impact of Disease (RAID) score could help identify the patients with rheumatoid arthritis (RA) who are best suited to a telemedicine consultation and could also promote holistic management of subjective symptoms that might otherwise be overlooked 1 .…”

“…In the new study, Mistry et al 1 assessed the performance of the RAID score relative to the 28-Joint Disease Activity Score (DAS28) in a cohort of 198 people with established RA. RAID was developed as a EULAR initiative to combine the most important PROs into one measure 6 .…”

“…Each domain is scored using a numeric rating scale, giving a total score of 0-10, with higher scores indicating greater disease impact. A RAID score of <2 is regarded as a Patient Acceptable Symptom State (PASS) 1 , that is, a symptom state that the patient considers acceptable. The PASS stems from the concept that feeling good is more that characterizes the disease and causes joint destruction and systemic comorbidity and to restore immune homeostasis.…”