Drivers of patient global assessment in patients with rheumatoid arthritis who are close to remission: an analysis of 1588 patients

ACR/EULAR Boolean remission in RA is frequently not obtained solely due to a patient global assessment (PGA) >1/10 (a condition often designated as near-remission). This study aimed to assess which domains of impact could explain an elevated PGA in near-remission patients. We performed an ancilla...

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Published in:Rheumatology (Oxford, England) England), 2017-09, Vol.56 (9), p.1573-1578
Main Authors: Ferreira, Ricardo J O, Dougados, Maxime, Kirwan, John R, Duarte, Cátia, de Wit, Maarten, Soubrier, Martin, Fautrel, Bruno, Kvien, Tore K, da Silva, José A P, Gossec, Laure
Format: Article
Language:English
Subjects:
Adaptation, Psychological
Adult
Aged
Arthritis, Rheumatoid - drug therapy
Arthritis, Rheumatoid - psychology
Biomarkers - blood
C-Reactive Protein - metabolism
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Patient Reported Outcome Measures
Remission Induction
Severity of Illness Index
Stress, Psychological - etiology
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Summary:ACR/EULAR Boolean remission in RA is frequently not obtained solely due to a patient global assessment (PGA) >1/10 (a condition often designated as near-remission). This study aimed to assess which domains of impact could explain an elevated PGA in near-remission patients. We performed an ancillary analysis of data from three cross-sectional studies in patients with established RA. Three disease activity states were defined: remission (tender and swollen joint counts, CRP and PGA all ⩽1), near-remission (tender and swollen joint counts, and CRP are all ≤1 but PGA >1) and non-remission. Physical and psychological domains were assessed using the RA Impact of Disease 0-10 (numeric rating scale) as explanatory factors of PGA. Univariable and multivariable linear regression analyses were performed to explain PGA. A total of 1588 patients (79.1% females) were analysed. The mean disease duration was 13.0 years (s.d. 9.8) and the 28-joint DAS with four variables was 3.2 (s.d. 1.4). Near-remission [mean PGA 3.6 (s.d. 1.9)] was more frequent (19.1%) than remission (12.3%). Scores of RA Impact of Disease domains were similar in near-remission and non-remission patients. In near-remission, PGA was explained (R2adjusted = 0.55) by pain (β = 0.29), function (β = 0.23), physical well-being (β = 0.19) and fatigue (β = 0.15). Near-remission was more frequent than remission. These patients, despite having no signs of significant inflammation, report an impact of disease similar to the non-remission patients. PGA in near-remission seems to be driven by physical rather than psychological domains. Selecting the best therapy for these patients requires a better understanding of the meaning of PGA, both globally and in individual patients.
ISSN:1462-0324
1462-0332
DOI:10.1093/rheumatology/kex211